Gholson C F, Dungan C, Neff G, Ferguson R, Favrot D, Nandy I, Banish P, Sittig K
Department of Medicine, Louisiana State University College of Medicine, Shreveport, USA.
Dig Dis Sci. 1998 Mar;43(3):534-9. doi: 10.1023/a:1018807023283.
To study how suspected postoperative biliary complications are influenced by surgical technique, we compared clinical profiles of 63 patients referred for ERCP after open (OC) and laparoscopic cholecystectomy (LC) over a four-year period. ERCP was not performed for postoperative pain alone and only six (9.5%) studies were normal. Referrals after LC were younger (mean 39.1 vs 53.6 years, P < 0.001) and ERCP was requested earlier (mean 71.6 vs 2360 days, P < 0.001) in the postoperative course. Choledocholithiasis (CDL) alone, the most common finding, was successfully managed with a single ERCP in 97.2% of cases. CDL after LC occurred in younger patients (35.5 vs 58.9 years, P < 0.01) who presented earlier (mean 98.6 days vs 5.1 years, P < 0.01), without biliary ductal dilatation (P < 0.01). Although CDL after LC was associated with higher ALT and bilirubin levels than after OC, the difference was not statistically significant. Cystic duct leaks (LC: six patients, OC: four patients) were typically associated with CDL after OC and 90% resolved with endoscopic therapy. Biliary ligation (four cases) was managed successfully with choledochojejunostomy. We conclude that findings at ERCP for suspected biliary obstruction or injury after OC or LC are similar and usually can be endoscopically managed. After LC, referrals currently are younger, present much earlier, and retained stones are less likely to be associated with ductal dilatation than after OC.
为研究手术技术如何影响术后胆系并发症，我们比较了在四年期间因开腹胆囊切除术（OC）和腹腔镜胆囊切除术（LC）后接受内镜逆行胰胆管造影（ERCP）检查的63例患者的临床资料。ERCP并非仅用于术后疼痛，仅有6例（9.5%）检查结果正常。LC术后转诊患者更年轻（平均39.1岁 vs 53.6岁，P < 0.001），且在术后病程中更早进行ERCP检查（平均71.6天 vs 2360天，P < 0.001）。单独胆总管结石（CDL）是最常见的检查结果，97.2%的病例通过单次ERCP成功处理。LC术后CDL发生在更年轻的患者中（35.5岁 vs 58.9岁，P < 0.01），出现时间更早（平均98.6天 vs 5.1年，P < 0.01），且无胆管扩张（P < 0.01）。尽管LC术后CDL患者的丙氨酸转氨酶（ALT）和胆红素水平高于OC术后患者，但差异无统计学意义。胆囊管漏（LC：6例患者，OC：4例患者）通常与OC术后的CDL相关，90%经内镜治疗后痊愈。胆管结扎（4例）通过胆总管空肠吻合术成功处理。我们得出结论，OC或LC术后怀疑胆系梗阻或损伤时，ERCP的检查结果相似，通常可通过内镜处理。与OC术后相比，LC术后转诊患者目前更年轻，就诊更早，残留结石与胆管扩张的相关性更低。
