Esber E J, Sherman S
Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, USA.
Gastrointest Endosc Clin N Am. 1996 Jan;6(1):57-80.
The expanding use of laparoscopic cholecystectomy in conjunction with intraoperative cholangiography and laparoscopic common bile duct exploration has caused a reexamination of the indications of preoperative ERCP. Several studies have demonstrated the benefits of early preoperative ERCP in patients with severe gallstone pancreatitis and acute cholangitis. Those patients with only mild biochemical or radiographic abnormalities suggestive of choledocholithiasis present a clinical dilemma. The optimal diagnostic and therapeutic approach in these patients will depend on the level of expertise of both the biliary endoscopist and laparoscopist. The interface of laparoscopic cholecystectomy and ERCP will continue to evolve as surgeons become more facile with the techniques of laparoscopic common bile duct exploration. When these laparoscopic skills become widely disseminated, the use of ERCP will most likely be relegated to its well-established role in the open cholecystectomy era.
腹腔镜胆囊切除术联合术中胆管造影及腹腔镜胆总管探查术的广泛应用，促使人们重新审视术前内镜逆行胰胆管造影（ERCP）的适应证。多项研究已证实，早期术前ERCP对重症胆石性胰腺炎和急性胆管炎患者有益。而那些仅有轻度生化或影像学异常提示胆总管结石的患者则面临临床困境。这些患者的最佳诊断和治疗方法将取决于胆道内镜医师和腹腔镜医师的专业水平。随着外科医生对腹腔镜胆总管探查技术越来越熟练，腹腔镜胆囊切除术与ERCP的结合将不断发展。当这些腹腔镜技术广泛普及后，ERCP的应用很可能会回归到其在开腹胆囊切除术时代已确立的角色。
