Carlson G L, Rhodes M, Stock S, Lendrum R, Lavelle M I, Venables C W
Department of Surgery, University of Newcastle upon Tyne, UK.
Br J Surg. 1992 Dec;79(12):1342-5. doi: 10.1002/bjs.1800791233.
Patients who continue to have or who develop abdominal pain after apparently successful cholecystectomy pose diagnostic difficulties. This study reports 384 such patients, investigated by endoscopic retrograde cholangiopancreatography (ERCP). There were 146 patients with abdominal pain alone with no previous history of common bile duct (CBD) exploration, of whom only 17 (11.6 per cent) had CBD stones on ERCP. Bile duct calculi were present in 76 of 140 patients (54.3 per cent) with abnormal biochemical findings (raised alkaline phosphatase and/or amylase level) and in 34 of 57 (60 per cent) with an abnormality detected on ultrasonography or intravenous cholangiography. A combination of biochemical and radiological abnormalities was present in 37 patients and was associated with CBD stones in 28 (76 per cent). Patients who had undergone CBD exploration represented a special group, of whom the majority (75 per cent) had common duct stones at ERCP even in the absence of biochemical and radiological abnormalities. ERCP is a useful investigation in patients with persistent postcholecystectomy symptoms. Other features in addition to pain or a history of CBD exploration may be relevant to the decision to perform ERCP in the investigation of these patients.
在胆囊切除术后看似成功但仍持续存在腹痛或出现腹痛的患者，诊断存在困难。本研究报告了384例此类患者，通过内镜逆行胰胆管造影（ERCP）进行检查。有146例患者仅出现腹痛，既往无胆总管探查史，其中仅17例（11.6%）在ERCP检查时发现胆总管结石。140例生化检查结果异常（碱性磷酸酶和/或淀粉酶水平升高）的患者中有76例（54.3%）存在胆管结石，57例超声检查或静脉胆管造影发现异常的患者中有34例（60%）存在胆管结石。37例患者同时存在生化和影像学异常，其中28例（76%）与胆总管结石有关。接受过胆总管探查的患者构成一个特殊群体，其中大多数（75%）即使在没有生化和影像学异常的情况下，在ERCP检查时也有胆总管结石。ERCP对于胆囊切除术后仍有持续症状的患者是一项有用的检查。除疼痛或胆总管探查史外的其他特征，可能与决定对这些患者进行ERCP检查有关。
