十二指肠镜对胆道术后并发症的诊断和治疗价值

目的探讨十二指肠镜对胆道术后并发症的诊断和治疗价值。方法回顾性分析53例采用十二指肠镜干预的胆道术后并发症患者的临床资料,评价十二指肠镜在胆道术后并发症诊断和治疗中的应用价值。结果胆道术后胆总管结石复发24例,结石残留12例,采用十二指肠镜取石成功率为94.4%。3例胆漏患者中1例乳头括约肌切开术和鼻胆管引流,1例鼻胆管引流治愈,1例内径逆行胰胆管造影（ERCP）明确诊断后开腹手术治愈。4例胆总管损伤狭窄患者中2例行鼻胆管引流后,经再次手术治愈,2例置入塑料胆道支架,症状消失。4例Oddis括约肌功能障碍患者中3例行内镜下括约肌切开术后症状消失,1例无效。3例盲袢综合征患者中括约肌切开术后症状改善。ERCP发现遗漏胆总管下端肿瘤3例。十二指肠镜术后并发胰腺炎2例,出血1例,并发症发生率5.36%,保守治疗后痊愈。结论胆道结石术后胆总管结石复发、残留是内镜干预最常见的适应证,十二指肠镜治疗部分胆漏和胆总管良性狭窄有效,对胆道术后遗留病变的识别和处理具有积极意义。

The Role of Duodenoscopy in the Treatment of Postoperative Complications of Biliary Surgery

Objective To evaluate the role of duodenoscopy in the treatment of postoperative complications of biliary surgery. Methods 53 cases with postoperative complications of biliary surgery, which were treated with duodenoscopy from Sept. 2001 to Nov. 2006, were reviewed retrospectively to assess the role of duodenoscopy in the treatment of postoperative complications of biliary surgery. Results The successful bile duct stone clearance rate of duodenoscopy is 94. 4% . For the 3 cases of bile leakage, 2 cases were cured and 1 diagnosed. 4 cases of biliary strictures were cured by duodenoscopy. Of the 4 cases of sphincter of Oddi dysfunction, 3 cases were cured and 1 failed. 3 cases of sump syndrome were cured. 3 cases of tumor at down common bile duct were detected by ERCP. The occurrence of complication of duodenoscopy is 5.36%. Conclusion Duodenoscopy is an effective treatment method for recurrent and retained stone and bile leakage after biliary surgery. It plays an active role in the pathology identification after biliary surgery and in the treatment of complications.