Traverso L W, Kozarek R A, Ball T J, Brandabur J J, Hunter J A, Jolly P C, Patterson D J, Ryan J A, Thirlby R C, Wechter D G
Department of Surgery, Virginia Mason Medical Center, Seattle, Washington 98111.
Am J Surg. 1993 May;165(5):581-6. doi: 10.1016/s0002-9610(05)80439-8.
We assessed the use of endoscopic retrograde cholangiopancreatography (ERCP) after laparoscopic cholecystectomy (LC) at our hepatobiliary referral center. This assessment included patients from outside institutions with post-LC problems. Between May 1990 and September 1992, we performed 522 LCs and 1,723 ERCP examinations. There were 78 patients who underwent 143 ERCP examinations after LC, 65% of whom were referred. ERCP findings were categorized as follows: normal results (8%), problems inherent to stone disease (65%), and iatrogenic injury (27%). The types of inherent problems were common bile duct (CBD) stones, pancreatitis, and papillary stenosis/microlithiasis. Within the CBD stone group, 5 of 26 patients also had papillary stenosis, and, within the pancreatitis group, 9 of 11 patients also had papillary stenosis, making papillary stenosis the most frequent observation (55%). Almost all of these patients (96%) required endoscopic papillotomy for successful treatment. The iatrogenic injury group was comprised of 21 patients, 16% of whom had cystic duct leak and 84% of whom had CBD injury. These patients required a variety of endoscopic procedures including endoscopic papillotomy (67%), CBD endoscopic stenting (76%), percutaneous drainage of biloma (29%), and percutaneous transhepatic biliary drainage (24%). Open surgical procedures after endoscopic assessment or treatment were required in only three patients in the iatrogenic group and in none in the inherent group. At this time, long-term follow-up is not possible with regard to biliary stricture. We conclude that the majority of problems after LC are either due to papillary stenosis/microlithiasis with or without CBD stones or to biliary injury. Both can be successfully diagnosed and treated with endoscopic techniques.
我们在我们的肝胆转诊中心评估了腹腔镜胆囊切除术（LC）后内镜逆行胰胆管造影（ERCP）的应用情况。这项评估纳入了来自外部机构、存在LC术后问题的患者。1990年5月至1992年9月期间，我们实施了522例LC手术和1723例ERCP检查。有78例患者在LC术后接受了143次ERCP检查，其中65%是被转诊而来。ERCP检查结果分类如下：正常结果（8%）、结石病固有问题（65%）和医源性损伤（27%）。固有问题的类型包括胆总管（CBD）结石、胰腺炎以及乳头狭窄/微结石症。在CBD结石组中，26例患者中有5例同时存在乳头狭窄，在胰腺炎组中，11例患者中有9例同时存在乳头狭窄，这使得乳头狭窄成为最常见的情况（55%）。几乎所有这些患者（96%）都需要进行内镜乳头切开术才能成功治疗。医源性损伤组由21例患者组成，其中16%有胆囊管渗漏，84%有CBD损伤。这些患者需要进行各种内镜操作，包括内镜乳头切开术（67%）、CBD内镜支架置入术（76%）、经皮胆汁瘤引流术（29%）和经皮经肝胆道引流术（24%）。医源性损伤组中只有3例患者在内镜评估或治疗后需要进行开放性手术，固有问题组则无患者需要。目前，关于胆管狭窄无法进行长期随访。我们得出结论，LC术后的大多数问题要么是由于伴有或不伴有CBD结石的乳头狭窄/微结石症，要么是由于胆管损伤。两者都可以通过内镜技术成功诊断和治疗。
