Goenka M K, Kochhar R, Nagi B, Bhasin D K, Chowdhury A, Singh K
Dept of Gastroenterology, PGIMER, Chandigarh.
J Assoc Physicians India. 1996 Feb;44(2):119-22.
The study was aimed to determine the role of endoscopic retrograde cholangiopancreatography (ERCP) in patients with postcholecystectomy symptoms in respect to interval of presentation following cholecystectomy. 170 patients with postcholecystectomy symptoms and negative upper gastrointestinal endoscopy were evaluated using ERCP. One hundred and seventeen (75%) out of 156 patients with successful ERCP had one or more abnormalities seen at ERCP. Bile duct stones (55 patients), benign strictures of bile duct (27 patients) were the common lesions detected. A significantly higher (p < 0.001) positive diagnosis was possible at ERCP in patients presenting with jaundice (100%) as compared to those without jaundice (61.8%). Spectrum of causes among patients presenting in early post-operative period (< 1 month) was somewhat different from those presenting later. Bile duct ligature and biliary fistula were the predominant causes in the former group, while stones and benign strictures were commoner in the patients presenting late. Endoscopic sphincterotomy and stone removal was performed successfully in 25 out of 30 patients in whom it was attempted. ERCP was found to be a very useful procedure in the management of postcholecystectomy symptoms. Spectrum of underlying disease was different in patients presenting before 1 month following cholecystectomy as compared to those presenting later.
本研究旨在确定内镜逆行胰胆管造影术（ERCP）在胆囊切除术后出现症状的患者中，与胆囊切除术后出现症状的时间间隔相关的作用。对170例胆囊切除术后出现症状且上消化道内镜检查阴性的患者进行了ERCP评估。156例成功进行ERCP的患者中，有117例（75%）在ERCP检查中发现一处或多处异常。胆管结石（55例）、胆管良性狭窄（27例）是常见的检出病变。与无黄疸的患者（61.8%）相比，有黄疸的患者（100%）在ERCP检查中获得阳性诊断的可能性显著更高（p < 0.001）。术后早期（<1个月）出现症状的患者与后期出现症状的患者病因谱有所不同。胆管结扎和胆瘘是前一组的主要病因，而结石和良性狭窄在后期出现症状的患者中更为常见。在尝试进行内镜括约肌切开取石术的30例患者中，有25例成功完成。ERCP被发现是处理胆囊切除术后症状的一种非常有用的方法。与后期出现症状的患者相比，胆囊切除术后1个月内出现症状的患者潜在疾病谱不同。
