113例胆囊切除术后黄疸患者ERCP的诊治

目的 了解造成胆囊切除术后患者残留上腹痛及黄疸症状的原因，比较ERCP及其他影像检查在此类患者检查中的价值。方法 回顾性分析113例胆囊切除术后残留上腹痛及黄疸症状并行ERCP检查患者的临床资料，比较分析患者行超声、CT等其他影像学检查以及ERCP检查对患者诊断的准确性及通过ERCP对患者治疗的效果。结果 113例患者中，最短术后5d，最长33年出现症状；ERCP检查前106例行CT检查，105例超声检查，检查3例PTC；ERCP检查对病因诊断准确性明显高于其他检查；通过ERCP对胆总管结石、胆管下端良性狭窄64例进行治疗并且效果良好；对不宜手术的胆管梗阻4例放置胆道支架能有效解除黄疸、缓解症状。结论 ERCP检查可明显提高患者病因诊断的准确率；基于ERCP的EST技术可对胆总管结石、胆管下端良性狭窄进行有效治疗，避免再次手术；对于不宜手术的胆管梗阻，可通过ERCP放置胆道支架解除黄疸，ERCP通过局部观察和组织活检对十二指肠乳头肿瘤的诊断是其他检查不可替代的。

The diagnosis and treatment in 113 cases with upper abdominal pain and jaundice after cholecystectomy

Objective To investigate the causes with upper abdominal pain and jaudice after cholecystectomy and to compare the values of ERCP and CT/ultrasonic scan in the diagnosis and treatment of these cases.Methods We had a retrospective survey in 113 cases with upper abdominal pain and jaudice after cholecystectomy and checked these cases by the ERCP.An analysis was made of the diagnostic accuracy with the ERCP,CT and ultrasonography.And the effectiveness of the treatment by ERCP/EST was follow up in 71 cases.Results 106 cases were checked by CT,105 cases by ultrasonography,3 cases by PTC.The diagnostic accuracy with ERCP was more accurate than the other checks.Conclusion ERCP may markedly improve the etiological diagnostic accuracy.The strictured distal common bile duct at the papilla of Vater and common duct stone may be effectively managed with EST based on ERCP.ERCP by ways of the local observation biopsy is of great significance in the diagnosis of the tumor of the duodenal major papilla.