胆石性胰腺炎经胆囊管胆道镜胆管探查的临床应用

探讨胆石性胰腺炎经胆囊管胆道镜胆总管探查的临床应用价值。方法自1997年1月～2001年12月，l0l例胆囊结石并急性胰腺炎行胆总管探查患者中，16例行胆总管切开探查和T管引流术，85例行胆镜经胆囊管胆总管探查。结果胆总管探查的阳性率为25.7％(26／101)，胆囊管扩张在5mm以上被认为是继发性胆总管结石导致胆源性胰腺炎的高危因素，其敏感性为88％，特异性为76％。结论胆囊管扩张在5mm以上是继发性胆总管结石导致胆源性胰腺炎的重要预测因素。胆道镜经胆囊管胆总管探查适用于胆囊结石并急性胰腺炎需行胆总管探查的患者。

CHOLEDOCHOFIBERSCOPIC COMMON BILE DUCT EXPLORATION THROUGH CYSTIC DUCT FOR GALLSTONE ACUTE PANCREATITIS

Objective To investigate the clinical value of choledochofiberscopic common bile duct exploration through cystic duct for galllstone acute pancreatitis.Methods From January 1997 to December 2001,101 patients with gallbladder stone acute pancreatitis underwent the common bile duct exploration.Among them,16 cases received choledochotomy and T tube drainage,85 cases underwent transcystic duct choledochoscopic exploration of common bile duct.Result The positive rate of common bile duct exploration was 25.7 %.Patients with cystic duct diameter above 5mm was considered to be at high risk of secondary choledocholithiasis inducing pancreatitis,which showed a sentivity of 88 per cent and specificity of 76 per cent in predicting secondary choledocholithiasis.Conclusion This study does show that the cystic duct diameter above 5mm is an important factor predicting choledocholithiasis in patients with gallstone acute pancreatitis. Transcystic duct choledochoscopic exploration of the common bile duct may be applied to the patients with gallbladder stone acute pancreatitis undergoing common bile duct exploration.