Aru G M, Davis C R, Elliott N L, Morris S J
Davis Memorial Gastrointestinal Diagnostic Laboratory, Crawford Long Hospital, Emory University, Atlanta, Ga, USA.
South Med J. 1997 Jul;90(7):705-8. doi: 10.1097/00007611-199707000-00011.
We reviewed our experience over 3 years with 11 patients who had bile leaks (Group 1) and 8 patients who had bile duct strictures after laparoscopic cholecystectomy (LC) and were treated with endoscopic retrograde cholangiopancreatography (ERCP) (Group 2). In Group 1, bile leaks were at the level of the cystic duct in 10 patients and from a duct of Luschka in 1 patient; 10 patients had sphincterotomy and 11 patients received barbed stents. All patients had resolution of bile leak and stents were removed after an average of 5 weeks. In Group 2, stenoses were at the level of the common bile duct (CBD) in 7 patients and of the CBD-common hepatic duct in 1 patient. Six patients had a sphincterotomy and 7 patients were successfully treated with pneumatic polyethylene balloon dilatation and stent placement. One patient had unsatisfactory dilatation and was referred to surgery. Two patients had permanent resolution of stenosis at 3 and 4 years of follow-up, 5 patients had recurrence, and a total of 6 patients eventually needed surgery. We conclude that ERCP is effective in resolving isolated bile leaks, but iatrogenic strictures after LC more often require surgical treatment after ERCP.
我们回顾了3年期间11例发生胆漏患者（第1组）和8例腹腔镜胆囊切除术（LC）后出现胆管狭窄并接受内镜逆行胰胆管造影（ERCP）治疗患者（第2组）的治疗经验。在第1组中，10例患者胆漏位于胆囊管水平，1例患者胆漏来自卢氏管；10例患者接受了括约肌切开术，11例患者置入了倒刺支架。所有患者胆漏均得到解决，支架平均在5周后取出。在第2组中，7例患者狭窄位于胆总管（CBD）水平，1例患者狭窄位于CBD-肝总管。6例患者接受了括约肌切开术，7例患者成功接受了气囊扩张和支架置入术。1例患者扩张效果不佳，转至外科手术治疗。2例患者在随访3年和4年时狭窄得到永久性解决，5例患者复发，共有6例患者最终需要手术治疗。我们得出结论，ERCP对于解决孤立性胆漏有效，但LC术后医源性狭窄在ERCP后往往更常需要手术治疗。
