Boender J, van Blankenstein M, Nix G A, Wilson J H, Dees J
Department of Diagnostic Radiology, University Hospital, Rotterdam-Dijkzigt, The Netherlands.
Endoscopy. 1992 Mar;24(3):203-7. doi: 10.1055/s-2007-1010463.
In patients suspected of having functional disorders of the papilla it is often difficult to establish the indications whether or not to perform endoscopic papillotomy (EP). We report on thirty-two consecutive patients referred for endoscopic retrograde cholangiopancreatography who all had longstanding biliary tract pain and episodes of liver enzyme elevation indicating cholestasis. Further features were: 1) a dilated common bile duct (CBD) after cholecystectomy (n = 11) or 2) a dilated CBD without or with larger (greater than cystic duct diameter) gallbladder stones (n = 6) or 3) multiple small gallbladder stones, with a normal or dilated CBD, in patients with signs of acute gallstone pancreatitis or in whom elective cholecystectomy was not indicated (n = 15). No CBD stones, organic obstruction or other disorders were found in these patients. Without further diagnostic procedures, EP was routinely performed. The laboratory (up to 3 months) and clinical findings (2 to 4 years follow up) showed improvement in all patients undergoing EP. We conclude that immediate EP appears justified in these selected patients.
对于疑似患有乳头功能紊乱的患者，往往难以确定是否进行内镜乳头切开术（EP）的指征。我们报告了连续32例因内镜逆行胰胆管造影术前来就诊的患者，他们均有长期的胆道疼痛和肝酶升高发作，提示胆汁淤积。其他特征包括：1）胆囊切除术后胆总管（CBD）扩张（n = 11）；2）无胆囊结石或有较大（大于胆囊管直径）胆囊结石时CBD扩张（n = 6）；3）在有急性胆石性胰腺炎体征或不适合择期胆囊切除术的患者中，有多个小胆囊结石，CBD正常或扩张（n = 15）。这些患者未发现CBD结石、器质性梗阻或其他疾病。未经进一步诊断程序，常规进行EP。实验室检查结果（长达3个月）和临床发现（随访2至4年）显示，所有接受EP的患者均有改善。我们得出结论，在这些选定的患者中立即进行EP似乎是合理的。
