胆囊切除术前上消化道检查的临床意义

目的: 调查术前上消化道检查对预测胆囊切除术后综合征的意义. 方法: 回顾调查了1997年1月~2000年10月在我院行胆囊切除术的患者1245例,其中522例术前行上消化道内镜检查,178例行上消化道钡餐造影检查,232例行上腹部平片检查.其中53例行胆囊造漏术,764例行胆囊切除术,52例行其他手术. 结果: 上消化道内镜检查发现166例合并浅表性胃炎,36例合并肥厚性胃炎,12例合并萎缩性胃炎,5例合并霉菌性胃炎,6例合并胃息肉,4例合并胃癌,25例合并上消化性溃疡,11例合并十二指肠乳头旁憩室,10例合并十二指肠滞留,2例合并轻中度食道静脉曲张,245例上消化道内镜检查无异常.上消化道钡餐造影检查发现8例合并十二指肠滞留,7例合并十二指肠乳头旁憩室,22例合并上消化性溃疡,141例上消化道钡餐造影检查正常.腹部平片检查对术前诊断无临床指导意义.术后59例产生了并发症及后遗症,如:胆道感染、急性胰腺炎、胆道蛔虫感染、胆瘘、胆道损伤以及肠粘连等. 结论: 胆囊术后综合征的发生与外科技术和其他上消化道并存疾病有关.术前上消化道检查对于预测胆囊术后综合征具有重要意义.

Clinical significance of upper digestive tract detection on the precholecystectomy

Objective:To investigate the clinical significance of upper digestive tract detection for the prediction of postcholecystectomy syndroms.Methods:We reviewed 1245 cases of cholecystectomy in our hospital from January 1997 through October 2000,in which 522 cases were carried out with endoscopy,178 cases with GI detection,232 cases with abdominal plain X ray,53 cases with cholecystic fistula operation,764 cases with cholecystectomy and 52 cases with other operations.Results:166 cases were found with chronic superficial gastritis,36 cases with hyperemic gastritis,12 cases with atrophic gastritis,5 cases with mold gastritis,6 cases with gastric hyperplastic polyp,4 cases with gastric cancer,25 cases with peptic ulcer,11 cases with parapapillary duodenal diverticula,10 cases with duodenal stasis,2 cases with middle and lower esophageal varices and 245 cases normal. GI showed 8 cases with duodenal stasis,7 cases with parapapillary duodenal diverticula,22 cases with peptic ulcer and 141 cases normal. The plain X ray showed nothing for clinic diagnosis. 59 cases developed complications and sequela,such as infection of biliary tract,acute pancreatitis,biliary round worm infection,biliary fistula,biliary injury,biliary disorder,surplus cholecystic cancer,adhension of intestine,abdominal pain and abdominal distention.Conclusion:The syndroms of postcholecystectomy are concerned with surgery technology and other diseases in upper digestive tract simultaneously. The upper digestive tract detections before operation are important for the pridiction of syndroms of postcholecystectomy.