内镜在胆囊切除术后综合征诊断和治疗中的应用价值

目的：探讨内镜在胆囊切除术后综合征（PCS）诊断和治疗中的应用价值。方法：对248例PCS病人行ERCP检查，根据不同病因，分别行内镜乳头插约肌切开术（EST）和／或内镜乳头气囊扩张术（EPBD），内镜鼻胆管引流（ENBD），内支架治疗，取石治疗等。结果：243例（98％）ERCP成功，未发现异常24例，胆管结石141例，138例经1－3次内镜取石取净，乳头狭窄38例，经EST或EPBD治疗1次成功，其余有乳头旁憩室压迫乳头开口，乳头肿瘤等40例，行EPBD或ENBD等治疗后，均有满意疗效，总的并发症发生率4．0％，结论：ERCP能及早发现胆囊切除术后综合征确切病因，内镜治疗胆管结石和乳头狭窄安全有效，并发症少。

Value of Endoscopy in Diagnosis and Treatment of Post-cholecystectomy Syndrome

Objective: To evaluate the value of endoscopy in diagnosis and treatment of post-cholecystectomy syndrome. Methods: ERCP was performed in 248 patents with PCS to identify the causes. According to different causes, the patients were treated by EST or/and EPBD, ENBD and biliary metal stent respectively. Results: ERCP was successfully performed in 243 cases (98%) and 24 of them had no abnormal endoscopic view. 141 cases had choledocholithiasis and stones in 138 cases were totally eliminated after one to three treatments. 38 cases had papillary stricture and were given EST or EPBD successfully one time. Other cases such as SOD, papillary tumor, etc, also achieved satisfying therapeutic effects. Total complications were noted in 10 cases (4.0%). Pancreatitis occurred in 7 cases, cholangitis in 2 cases and hemorrhage of upper gastrointestinal tract in one case. Conclusions: ERCP can find definite cause of PCS at early stage. Endoscopic therapy for choledocholithiasis and papillary stricture is a safe and effective method with few complications. The complications of ERCP can be reduced by skillful operation.