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首页> 外文期刊>Surgical Endoscopy >Endoscopic diagnosis and management of complications following surgery for gallstones.
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Endoscopic diagnosis and management of complications following surgery for gallstones.

机译：胆结石手术后的内窥镜诊断和并发症处理。

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BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is increasingly being performed for therapeutic purposes. This report reviews our experience in an attempt to determine the role and efficacy of ERCP in the management of postoperative complications following surgery for gallstones. METHODS: This study analyzes ERCP records of 418 patients performed in a single referral center after a surgery for gallstones, in the period from December 1991 to June 2000. RESULTS: A total of 451 endoscopic procedures were performed for 418 patients. The primary operations which required ERCP and were included in the study were laparoscopic cholecystectomy (n = 161, 38.5%), choledocholithotomy and T-tube drainage (n = 157, 37.5%), open cholecystectomy (n = 82, 19.6%), choledochoduodenostomy (n = 14, 3.3%), and cholecystostomy (n = 4, 1%). Procedure was carried out successfully in 403 patients (96.4%), whereas a proper endoscopic diagnosis was not achieved in 15 (3.5%). Retained biliary stones (without any associated abnormality) were found in 163 (38.9%), ductal injuries in 44 (10.5%), biliary strictures in 21 (5.0%), papillary stenosis in 36 (8.6%), cystic stump leak (with or without retained stones) in 30 (7.1%), leak from T-tube tract (with/or without retained stones) in 20 (4.8%), and unsuspected malignancies in 18 (4.3%). A sole diagnostic cholangiography was obtained in 63 patients (15.0%). Patients were managed by debris or stone extraction in 169 (40.4%), endoscopic sphincterotomy (ES) in 145 patients (34.6%), stent insertion in 19 (4.5%), or dilatation in 2 (0.4%). Overall successful stone removal rate was 97.4%. Thirty-nine patients with normal cholangiographic findings underwent ES for the relief of presenting signs and symptoms. ERCP-related morbidity was 13.6%. CONCLUSIONS: The need for ERCP is rising, especially for stones retained after cholecystectomies. Endoscopy offers safe and effective methods in the treatment of bile leaks, unless associated with major ductal injuries. ES is a reasonable method for treating papillary stenosis and some post-cholecystectomy pain or symptoms.
机译：背景：内镜逆行胰胆管造影（ERCP）正越来越多地用于治疗目的。本报告回顾了我们的经验，以试图确定ERCP在胆结石手术后并发症管理中的作用和功效。方法：本研究分析了1991年12月至2000年6月在胆结石手术后在单个转诊中心进行的418例患者的ERCP记录。结果：共对418例患者进行了451例内窥镜检查。该研究中需要进行ERCP的主要手术包括腹腔镜胆囊切除术（n = 161，38.5％），胆总管切开取石术和T管引流术（n = 157，37.5％），开腹胆囊切除术（n = 82，19.6％），胆总管十二指肠吻合术（n = 14，3.3％）和胆囊造口术（n = 4，1％）。在403例患者中成功进行了手术（96.4％），而在15例（3.5％）中未获得适当的内镜诊断。保留胆结石（无相关异常）163例（38.9％），导管损伤44例（10.5％），胆道狭窄21例（5.0％），乳头狭窄36例（8.6％），胆囊残基漏出（有有或没有结石的患者中有30例（7.1％），有T管漏出（有/没有结石的患者）中有20例（4.8％），有18例患者的意外恶性肿瘤（4.3​​％）。 63例患者获得了唯一的诊断性胆道造影（15.0％）。患者接受杂物或结石摘除169例（40.4％），内镜括约肌切开术（ES）145例（34.6％），支架置入19例（4.5％）或扩张2例（0.4％）。总体成功结石清除率为97.4％。 39名胆管造影检查结果正常的患者接受了ES治疗，以缓解体征和症状。 ERCP相关的发病率为13.6％。结论：对ERCP的需求正在增加，特别是对于胆囊切除术后残留的结石。内镜检查可提供安全有效的方法来治疗胆漏，除非与严重的导管损伤有关。 ES是治疗乳头状狭窄和一些胆囊切除术后疼痛或症状的合理方法。

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