十二指肠镜治疗胆道术后并发症34例分析

目的探讨十二指肠镜在治疗胆道手术术后并发症中的应用价值。方法回顾性分析近10年(2000年1月～2010年1月)胆道手术术后并发症在我院行十二指肠镜治疗34例病例。胆总管残余结石行乳头括约肌切开及气囊扩张术取石23例;胆漏行鼻胆管引流(ENBD)治疗7例,其中LC术后胆漏5例,胆道探查引起胆瘘2例;胆管狭窄行胆管球囊扩张,放置胆管塑料内支架2例;肝门胆管癌术后再狭窄及胆道术后胆道不通行金属支架治疗2例。结果 23例胆总管残余结石患者经乳头括约肌切开及气囊扩张术取石,其中有5例经碎石操作取净结石。7例胆漏患者经鼻胆管引流2~3周后胆漏闭合,无严重并发症发生。2例胆管狭窄患者经胆管球囊扩张、放置胆管内支架治愈。2例恶性肿瘤患者安置金属支架一年内未发生胆管炎。结论十二指肠镜在治疗胆道术后并发症中具有重要应用价值,是胆总管残余结石、胆漏及胆管狭窄和恶性梗阻治疗的很好方法。

Analysis of Duodenoscopy for the Treatment of Complications after Biliary Tract Operation of 34 Cases

Objective To estimate the values of duodenoscopy in the treatment of complications after biliary tract operation.Methods All the 34 cases treated with ERCP were analyzed retrospectively,including 23 patients with calculus in bile dust after laparoscopic cholecystectomy given endoscopic sphincterotomy or balloon dilatation was taken out choledocholith,7 patients with postoperative bile leakage after biliary surgical procedures,in which there were 5 cases after LC and 2 cases of biliary tract exploration,they were given the endoscopic nasobiliary drainage.Four patients with biliary tract stricture after LC were treated by bile balloon dilatation,endoscopic stenting in biliary duets.Results 23 patients with choledocholith residual after LC and biliary tract exploration were given the EST or EPBD to take out choledocholith,including 3 cases of the two operations to take out choledocholith.There were no serious complications in 7 patients with biliary fistulas and the biliary fistulas were healed completely by ENBD after 2 to 3 weeks.Two patients with stricture of bile ducts were cured by bile balloon dilatatio,endoscopic stenting in biliary.Conclusion ERCP is a important therapy method of complications after biliary tract operation,which include retained calculus of common bile duct,bile leakage,stenosis of bile duct and vicious obstruction.