Siegel J H, Cohen S A
Beth Israel Medical Center-North Division, New York, NY.
Gastroenterologist. 1994 Mar;2(1):5-13.
Laparoscopic technique has become the norm for cholecystectomy, one of the most commonly performed operations. Unfortunately, the advent of laparoscopic cholecystectomy has been accompanied by a significant increase in bile duct injuries and a new set of postsurgical problems when compared with traditional, open cholecystectomy. Endoscopic retrograde cholangiopancreatography (ERCP) has emerged as a central method for diagnosis and treatment of bile duct injuries and other problems arising after laparoscopic cholecystectomy. The most common biliary problems include bile leaks from the cystic duct remnant or one of the main ducts; ductal injury, such as disruption or strictures; retained common bile duct stones; or postoperative biliary-pancreatic pain. Building on the success of endoscopic treatment of biliary complications of traditional surgery, ERCP, in cooperation with radiological and surgical intervention, can facilitate definitive diagnosis and treatment of bile leaks and simple strictures. Complex strictures and complete disruptions are not amenable to endoscopic therapy and should be treated surgically. As experience in laparoscopic cholecystectomy increases, the incidence of bile duct injuries should decline; ERCP, however, will remain a valuable adjunctive modality.
腹腔镜技术已成为胆囊切除术（最常开展的手术之一）的标准术式。不幸的是，与传统的开放式胆囊切除术相比，腹腔镜胆囊切除术的出现伴随着胆管损伤显著增加以及一系列新的术后问题。内镜逆行胰胆管造影术（ERCP）已成为诊断和治疗腹腔镜胆囊切除术后胆管损伤及其他问题的核心方法。最常见的胆道问题包括胆囊管残端或主要胆管之一的胆汁漏；导管损伤，如断裂或狭窄；胆总管结石残留；或术后胆胰疼痛。基于传统手术胆道并发症内镜治疗的成功经验，ERCP与放射学和外科干预协作，可促进胆汁漏和单纯狭窄的明确诊断与治疗。复杂狭窄和完全断裂不适合内镜治疗，应进行手术治疗。随着腹腔镜胆囊切除术经验的增加，胆管损伤的发生率应会下降；然而，ERCP仍将是一种有价值的辅助手段。
