ERCP结合EPT对胆囊切除术后患者诊治价值的探讨

目的 回顾性研究逆行性胰胆管造影（ERCP）结合乳头肌切开术（EPT）对胆囊切除术后患者的诊治价值。方法 170例胆囊切除术后症状再发或反复发作患者，接受ERCP检查和EPT等治疗，诊断结果与B超作对照。同时动态观察内镜下介入诊治术后临床表现的改变。不良反应及血清淀粉酶的变化及高淀粉酶血症的分布情况。结果 经ERCP结合EPT等术后患者临床症状显著改善；与B超对照ERCP对胆囊切除术后胆总管残余结石的诊断率显著提高（P＜0．001），对胆总管扩张程度的诊断价值显著优于B超（P＜0．05），并能发现许多B超检查不能发现的胆胰病变；术后主要不良反应表现为出血、高淀粉酶血症，ERCP结合EPT等治疗组高淀粉酶的发生率显著高于单纯ERCP操作组（P＜0．01）。经积极地处理后短期内出血控制，血清淀粉酶多在3日内转为正常。结论 对胆囊切除术后患者，ECRP结合EPT不失为一项非常有价值、安全的诊治措施。

Diagnostic and therapeutic value of endoscopic retrograde cholangiopancreatography combined with endoscopic papillo-sphinctecotomy in patients undergone postcholecystectomy

Aim To retrospectively study the diagnostic and therapeutic value of endoscopic retrograde cholangiopancreatography(ERCP) combined with endoscopic papillosphincterotomy(EPT) in patients undergone postcholecystectomy.Methods Patients( n =170) with postcholecystectomy who had recurrent symptoms underwent ERCP and EPT.The diagnoses by ERCP were controlled with that by B ultrasonography.And we observed the operational complication of ERCP or EPT,the changes of clinical situation and serum amylase,and the distribution of hyperamylasemia.Results The clinical symptoms improved after ERCP combined with EPT,the diagnostic rate of common bile duct remnant stone by ERCP compared with that by B ultrasonography increased significantly( P <0.001) and the diagnostic value for the degree of common bile duct dilatation by ERCP was strikingly higher than that by B ultrasonography( P <0.05).In addition,some bile ductal and pancreatic pathological changes that could not be discovered by B ultrasonography could be found by ERCP.The main operational complications were hemorrhage and hyperamylasemia,The incidence rate of the latter in the patients treated by ERCP combined with EPT was notably higher than that by ERCP only( P <0.01).The hemorrhage could often be controlled in a short time through active treatment.The level of serum amylase usually returned to normal range in 3 days.Conclusion ERCP combined with EPT for patients suffered from postcholecystectomy complications can be considered as a quite valuable and pretty safe measure in the diagnosis and treatment as well.