Experience of ERCP in The Diagnosis and Treatment of Abdominal Pain after Simple Cholecystectomy (Report of 43 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 朱兴 , 孙铎 , 杨俊青

沈阳市第四人民医院肝胆外科（辽宁沈阳 110031）;

Corresponding author：

朱兴, Email: zhuxing9248@sina.com

Keywords：

胆囊切除术后综合征; 内镜逆行胰胆管造影; Oddi括约肌切开术; 腹痛

DOI：

10.7507/1007-9424.20140306

Video：

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目的探讨经内镜逆行胰胆管造影（ERCP）治疗胆囊切除术后腹痛的治疗效果。方法对2007年6月至2013年6月期间笔者所在医院收治的43例胆囊切除术后腹痛患者的临床资料行回顾性分析。结果 43例胆囊切除术后腹痛患者均行ERCP诊治，其中胆总管下端狭窄14例，胆总管下端结石19例，胆总管下端狭窄合并结石10例。分别行Oddi括约肌切开术（EST）12例，单纯气囊扩张治疗2例，气囊扩张取石19例，EST+气囊扩张取石10例；其中1例因狭窄段超过2 cm而行气囊扩张+塑料内支架置入治疗。症状完全缓解37例，部分缓解4例，2例无效（单纯气囊扩张者）。43例均获随访，随访时间（30.7±10.4）个月（11～72个月）；有3例EST术后因瘢痕形成再狭窄而再次行EST术，症状缓解。结论 ERCP治疗胆囊切除术后胆管下端狭窄或结石引起的腹痛是一种安全、微创和疗效确切的方法。

Citation： 朱兴, 孙铎, 杨俊青. Experience of ERCP in The Diagnosis and Treatment of Abdominal Pain after Simple Cholecystectomy (Report of 43 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(10): 1287-1288. doi: 10.7507/1007-9424.20140306 Copy

1.	朱爱军, 石景森.胆囊切除术后综合征的再认识[J].中国普外基础与临床杂志, 2010, 17(4):314-316.
2.	贺兆斌, 孙久政, 姜华, 等.胆囊切除术与术后胆总管结石关系的回顾性临床研究[J].中国现代普通外科进展, 2013, 16(1):19-22.
3.	Steven S, Amy I, David CL, et al. Postcholecystectomy biliary symptoms[J]. J Surg Edu, 2007, 64(4):228-234.
4.	Jaunoo SS, Mohandas S, Almond LM. Postcholecystectomy syndrome (PCS)[J]. Int J Surg, 2010, 8(1):15-17.
5.	Schofer JM. Biliary causes of postcholecystectomy syndrome[J]. J Emerg Med, 2010, 39(4):406-410.
6.	胡晋太, 蔡晚霞.避免腹腔镜胆囊切除术后胆总管残留结石的体会[J].腹腔镜外科杂志, 2011, 16(11):835-837.
7.	Schirmer BD, Winters KL, Edilich RF. Cholelithiasis and cholecystitis[J]. J Long Term Eff Med Implants, 2005, 15(3):329-338.
8.	邹浩, 戈佳云, 张小文, 等. MRCP在预防LC手术并发症中的价值[J].中国普外基础与临床杂志, 2011, 18(9):973-977.
9.	高峰玉, 纪瑞霞, 梁玉彩, 等.内镜下乳头括约肌球囊扩张术在胆囊切除术后综合征诊治中的应用价值[J].中国内镜杂志, 2013, 19(9):977-979.
10.	Yang XM, Hu B. Endoscopic sphincterotomy plus large-balloon dilation vs. endoscopic sphincterotomy for choledocholithiasis:a meta-analysis[J]. World J Gastroenterol, 2013, 19(48):9453-9460.
11.	温德才, 孙东华, 郭仁宣, 等. Oddi括约肌狭窄的诊治体会[J].中华普通外科杂志, 2006, 21(10):709-711.
12.	张松柏, 郭晓平, 王志刚, 等.胆囊切除术后Oddi括约肌功能障碍的内镜治疗[J].中国微创外科杂志, 2008, 8(9):803-804.
13.	王永向, 吴涛, 纪宗正, 等.胆囊切除术奥狄括约肌功能障碍的内镜治疗[J].中华消化内镜杂志, 2002, 19(1):21-23.
14.	Li X, Zhu K, Zhang L, et al. Periampullary diverticulum may be an important factor for the occurrence and recurrence of bile duct stones[J]. World J Surg, 2012, 36(11):2666-2669.
15.	Stefănescu G, Bălan G, Stanciu C. The relationship between bile reflux and symptoms in patients with gallstones before and after cholecystectomy[J]. Rev Med Chir Soc Med Nat Iasi, 2009, 113(3):698-703.
16.	李丹丹, 张斌, 李长锋, 等.十二指肠镜下诊断和治疗胆囊切除术后胆道型Oddi括约肌功能障碍[J].中国微创外科杂志, 2010, 10(5):409-411.

1. 朱爱军, 石景森.胆囊切除术后综合征的再认识[J].中国普外基础与临床杂志, 2010, 17(4):314-316.
2. 贺兆斌, 孙久政, 姜华, 等.胆囊切除术与术后胆总管结石关系的回顾性临床研究[J].中国现代普通外科进展, 2013, 16(1):19-22.
3. Steven S, Amy I, David CL, et al. Postcholecystectomy biliary symptoms[J]. J Surg Edu, 2007, 64(4):228-234.
4. Jaunoo SS, Mohandas S, Almond LM. Postcholecystectomy syndrome (PCS)[J]. Int J Surg, 2010, 8(1):15-17.
5. Schofer JM. Biliary causes of postcholecystectomy syndrome[J]. J Emerg Med, 2010, 39(4):406-410.
6. 胡晋太, 蔡晚霞.避免腹腔镜胆囊切除术后胆总管残留结石的体会[J].腹腔镜外科杂志, 2011, 16(11):835-837.
7. Schirmer BD, Winters KL, Edilich RF. Cholelithiasis and cholecystitis[J]. J Long Term Eff Med Implants, 2005, 15(3):329-338.
8. 邹浩, 戈佳云, 张小文, 等. MRCP在预防LC手术并发症中的价值[J].中国普外基础与临床杂志, 2011, 18(9):973-977.
9. 高峰玉, 纪瑞霞, 梁玉彩, 等.内镜下乳头括约肌球囊扩张术在胆囊切除术后综合征诊治中的应用价值[J].中国内镜杂志, 2013, 19(9):977-979.
10. Yang XM, Hu B. Endoscopic sphincterotomy plus large-balloon dilation vs. endoscopic sphincterotomy for choledocholithiasis:a meta-analysis[J]. World J Gastroenterol, 2013, 19(48):9453-9460.
11. 温德才, 孙东华, 郭仁宣, 等. Oddi括约肌狭窄的诊治体会[J].中华普通外科杂志, 2006, 21(10):709-711.
12. 张松柏, 郭晓平, 王志刚, 等.胆囊切除术后Oddi括约肌功能障碍的内镜治疗[J].中国微创外科杂志, 2008, 8(9):803-804.
13. 王永向, 吴涛, 纪宗正, 等.胆囊切除术奥狄括约肌功能障碍的内镜治疗[J].中华消化内镜杂志, 2002, 19(1):21-23.
14. Li X, Zhu K, Zhang L, et al. Periampullary diverticulum may be an important factor for the occurrence and recurrence of bile duct stones[J]. World J Surg, 2012, 36(11):2666-2669.
15. Stefănescu G, Bălan G, Stanciu C. The relationship between bile reflux and symptoms in patients with gallstones before and after cholecystectomy[J]. Rev Med Chir Soc Med Nat Iasi, 2009, 113(3):698-703.
16. 李丹丹, 张斌, 李长锋, 等.十二指肠镜下诊断和治疗胆囊切除术后胆道型Oddi括约肌功能障碍[J].中国微创外科杂志, 2010, 10(5):409-411.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Experience of ERCP in The Diagnosis and Treatment of Abdominal Pain after Simple Cholecystectomy (Report of 43 Cases)

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