外科  >> Vol. 3 No. 3 (July 2014)

ERCP对腹腔镜胆囊切除术后急性胰腺炎的早期治疗效果
Value of ERCP in Early Diagnosis and Treatment of Acute Pancreatitis after Laparoscopic Cholecystectomy

DOI: 10.12677/HJS.2014.33007, PDF, HTML, 下载: 1,950  浏览: 6,596 

作者: 郝余庆, 李 恒, 寇玉彬:上海宝山医院,上海

关键词: 内镜急性胰腺炎内镜逆行性胰胆管造影术腹腔镜胆囊切除术Endoscopy Acute Pancreatitis Endoscopic Retrograde Cholangiopancreatography Laparoscopic Cholecystectomy

摘要: 目的:观察ERCP对腹腔镜胆囊切除术(laparoscopic cholecystectomy LC)后出现急性胰腺炎(acute pancreatitis AP)的早期治疗效果。方法:收集2005年6月至2013年12月47例AP患者(均是胆囊结石腹腔镜胆囊切除术后),所有患者住院行ERCP + EST治疗,术中放置鼻胆管(Endoscopic naso-biliary drainage, ENBD)9例,胆管支架4例。结果:术中发现胆总管结石36例,9例胆总管下端狭窄,2例胆总管下端恶性肿瘤。术后未出现十二指肠穿孔、胰腺炎加重等严重并发症。结论:胆道因素依然是LC术后急性胰腺炎的首要因素,ERCP治疗腹腔镜胆囊切除术后急性胰腺炎有显著疗效。
Abstract: Objective: To investigate the value of endoscopic retrograde cholangiopancreatitis (ERCP) in early diagnosis and treatment of acute pancreatitis after laparoscopic cholecystectomy (LC). Methods: The data of 47 cases with acute pancreatitis after LC in our hospital from June 2005 to December 2013 were retrospectively analyzed. All cases were treated with ERCP + EST, 9 cases were cured with ENBD, 4 cases were placed stent. Result: 36 cases were choledocholithiasis, 9 cases were common bile duct stricture, 2 cases were maligment, and there was no severe complication after ERCP, such as gastroduodenal perforation. Conclusion: The major cause of acute pancreatitis after LC was biliary factor. For these cases, the treatment by ERCP was safe and effective.

文章引用: 郝余庆, 李恒, 寇玉彬. ERCP对腹腔镜胆囊切除术后急性胰腺炎的早期治疗效果[J]. 外科, 2014, 3(3): 30-33. http://dx.doi.org/10.12677/HJS.2014.33007

参考文献

[1] 柏愚, 李兆申 (2006) 急性胆源性胰腺炎内镜治疗进展. 胰腺病学, 6, 58-60.
[2] 中华医学会外科学分会胰腺学组 (1997) 急性胰腺炎临床诊断及分级标准. 中华外科杂志, 35, 773-775.
[3] 江鸿志, 曹世植 (1996) 实用消化内科手册. 人民军医出版社, 北京, 462-464.
[4] Sherman, S., Gottieb, K. and Lehman, G.A. (1994) Therapeutic biliary endoscopy. Endoscopy, 26, 93-112.
[5] British Society of Gastroenterology (1998) United Kingdom guideline for the management of acute pancreatitis. Gut, 42, s1-s13.
[6] Uhl, W., Warshaw, A., Imrie, C., et al. (2002) IAP guidelines for the surgical management of acute pancreatitis. Pan- creatology, 2, 565-573.
[7] 冷凯, 曾鹏飞, 主鹤亭 (2008) 急性胆源性胰腺炎的内镜治疗. 中国内镜杂志, 14, 774-776.
[8] 田伏洲, 张丙印, 黎冬暄等 (2005) 内镜胆管减压治疗急性胰腺炎20年探索与思考. 中国实用外科杂志, 25, 347-349.
[9] Working Party of the British Society of Gastroenterology, Association of Surgeons of Great Britain and Ireland, Pan- creatic Society of Great Britain and Ireland (2005) UK guidelines for the management of acute pancreatitis. Gut, 54, 1-9.
[10] 黄平, 张啸, 张筱风等 (2008) 急性胆源性胰腺炎早期内镜治疗得再认识. 中国内镜杂志, 14, 860-863.