ERCP在胆囊切除术后综合征诊治中应用价值.docVIP

ERCP在胆囊切除术后综合征诊治中应用价值 　　【摘要】 目的 分析经内镜逆行性胰胆管造影术（ERCP）在胆囊切除术后综合征诊治中的应用价值。方法 60例胆囊切除术后综合征患者， 所有患者均进行B超、CT和ERCP检查， 并记录其病因检查结果。结果 60例患者中， ERCP检查出56例， 准确率为93.33%；B超检查出22例， 准确率为36.67%；CT检查出28例， 准确率为46.67%；ERCP检查准确率显著高于B超和CT检查， 差异有统计学意义（P0.05）。在病因检查中， B超、CT检查均无法诊断出胆囊管残端过长和壶腹肿瘤， 在胆管损伤、胆管结石、十二指肠乳头狭窄中的漏诊率也很高。结论 ERCP在胆囊切除术后综合征诊治中准确性高， 同时检查出的病因也更为明确， 应在临床治疗胆囊切除术后综合征中大力推广使用。 　　【关键词】 胆囊切除术后综合征；经内镜下逆行胰胆管造影术；B超检查；CT检查 　　【Abstract】 Objective To analyze the application value of endoscopic retrograde cholangiopancreatography （ERCP） in diagnosis and treatment of postcholecystestomy syndrome. Methods A total of 60 postcholecystestomy syndrome patients all received B ultrasound， CT and ERCP examination， and their causes of examination were recorded. Results Among 60 patients， there 56 detected cases by ERCP examination， with accuracy as 93.33%， 22 detected cases by B ultrasound examination， with accuracy as 36.67%， 28 detected cases by CT examination， with accuracy as 46.67%. Accuracy by ERCP examination was significantly higher than that of B ultrasound and CT examination， and the difference had statistical significance （P0.05）. In etiology examination， B ultrasound and CT examination could not diagnose overlong cystic duct stump and ampullary cacinoma， and their incidence of missed diagnosis in bile duct injury， bile duct stones and duodenal papillary stenosis was also high. Conclusion ERCP shows high accuracy in diagnosis and treatment of cholecystectomy syndrome， and the causes of disease examined by ostcholecystestomy syndrome are more clear. Therefore it should be promoted in clinical treatment of postcholecystestomy syndrome. 　　【Key words】 Postcholecystestomy syndrome； Endoscopic retrograde cholangiopancreatography； B ultrasound examination； CT examination 　　?囊切除术后综合征是指患者在进行胆囊切除后， 出现了相关胆道疾病的症状， 比如腹痛、压迫感、肋部疼痛[1]。正常情况， 在出现不适症状后， 短时间内会消失， 但是也有部分患者因为手术原因或者其他药物原因等相关症状持续时间较长， 临床上将这种情况称之为胆囊切除术后综合征[2]。目前在临床中针对胆囊切除术后综合征患者进行的检查方法主要有B超、CT、ERCP。ERCP自报道以来已经成为多种疾病的诊断手法[3]。本文现根据本院2014年10月～2