Lim C C, Law N M, Cheng J, Ng H S
Department of Medicine II, Singapore General Hospital.
Singapore Med J. 1994 Dec;35(6):571-4.
Therapeutic Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is an established mode of treatment for bile duct lesions.
This paper reviews the role of ERCP in the management of bile duct lesions developing after biliary surgery.
Of the 894 ERCPs performed in our department between January 1990 and May 1992, 23 (13 female, 10 male) were for patients with post-operative bile duct lesions. The mean age of these 23 patients was 59 years (range 38-91 years). The previous biliary surgical procedures were conventional cholecystectomy (n = 19), laparoscopic cholecystectomy (n = 3) and a cholecystectomy with choledochojejunostomy. Associated medical conditions of ischaemic heart disease, unstable angina, hypertensive heart disease, chronic obstructive airway disease and hepatitis B cirrhosis were present in 7 of these patients.
Ten patients had benign biliary strictures. Endoscopic stenting (with one or 2 stents) was successful in 9. The strictures reopened in 2 patients after a total stenting duration of 12 and 18 months respectively. Four patients had biliary leakages that were successfully treated with stenting. Two patients had spontaneous sealing of biliary leak at 3 and 6 months respectively. Nine patients had retained stones (7 with solitary stone, 2 with multiple stones) that were successfully removed with Dormia basket after sphincterotomy. Complications were few and manageable.
Therapeutic ERCP is safe and effective. It is a useful adjunct in the management of patients with post-operative biliary lesions.
治疗性内镜逆行胰胆管造影术（ERCP）是胆管病变的一种既定治疗方式。
本文回顾了ERCP在胆管手术后发生的胆管病变管理中的作用。
1990年1月至1992年5月间在我科进行的894例ERCP中，有23例（13例女性，10例男性）是针对术后胆管病变患者。这23例患者的平均年龄为59岁（范围38 - 91岁）。先前的胆道手术方式包括传统胆囊切除术（n = 19）、腹腔镜胆囊切除术（n = 3）以及胆囊切除加胆总管空肠吻合术。其中7例患者伴有缺血性心脏病、不稳定型心绞痛、高血压性心脏病、慢性阻塞性气道疾病和乙型肝炎肝硬化等相关疾病。
10例患者有良性胆管狭窄。内镜下置入支架（1个或2个支架）9例成功。分别在置入支架总时长12个月和18个月后，2例患者的狭窄复发。4例胆漏患者经支架置入成功治疗。2例患者的胆漏分别在3个月和6个月时自行闭合。9例患者有残留结石（7例为单个结石，2例为多个结石），经括约肌切开术后用多尔米亚网篮成功取出。并发症少且可控。
治疗性ERCP安全有效。它是术后胆管病变患者管理中的一种有用辅助手段。
