壶腹周围疾病对内镜保胆取石手术疗效的影响

The influence of periampullary disease on the curative effect of endoscopic invasive cholecystolithotomy with gallbladder

摘要:

目的 探讨壶腹周围疾病对内镜保胆取石手术疗效的影响。方法 回顾性分析2009年12月-2012年12月该科腹腔镜辅助内镜保胆取石术后再次入院治疗的24例伴有壶腹周围疾病患者的临床资料。结果 24例患者中Oddi括约肌功能障碍（SOD）胆型8例，SOD胰型2例，SOD混合型1例，以腹痛为主要表现。十二指肠乳头憩室5例，胆胰合流异常4例，十二指肠乳头炎3例，十二指肠乳头癌1例，其中6例表现为胆囊造瘘管拔除后经瘘道持续性胆汁外漏，5例表现为胆囊内胆泥淤积/泥沙样结石，2例表现为上腹部疼痛。10例SOD患者经解痉抑酸治疗后缓解，1例胆型SOD因药物治疗无效而采取十二指肠镜治疗后缓解；5例胆囊内胆泥淤积/泥沙样结石患者口服胆石利通片及牛磺熊去氧胆酸胶囊1个月以上无效；6例胆汁外漏患者采取局部瘘道缝合无效；5例十二指肠乳头憩室、4例胆胰合流异常、3例十二指肠乳头炎及1例十二指肠乳头癌患者采取十二指肠镜治疗后症状消失。结论 壶腹周围疾病是内镜保胆取石术胆囊造瘘管拔除后经瘘道持续性胆汁外漏，腹痛及胆囊结石复发的重要原因。

Abstract:

【Objective】 To investigate the influence of periampullary diseases on the curative effect of endoscopic invasive cholecystolithotomy with gallbladder. 【Methods】 The clinical data of 24 cases with periampullary disease after endoscopic invasive cholecystolithotomy with gallbladder from December 2009 to December 2012 were analyzed retrospectively. 【Results】 Abdominal pain was the main performance in eight cases of sphincter of Oddi dysfunction (SOD) biliary type, two cases of SOD pancreatic type and one case of SOD hybrid type. Six cases showed persistent bile leakage through the fistulous tract after removal of cholecystostomy tube, five cases showed biliary sludge siltation/muddy stone in gallbladder, and two cases showed abdominal pain which was made of five cases of duodenal papilla diverticulum, four cases of anomalous pancreaticobiliary ductal union, three cases of duodenal papillitis and one case of duodenal papilla carcinoma. Ten cases of SOD were released for antispasmodic and acid suppression, but one case of SOD was released for duodenoscopes therapy after useless pharmacotherapy. Tauroursodeoxycholic acid capsule was useless for the five cases of biliary sludge siltation/muddy stone in gallbladder. Local fistula suture was useless for the six cases of bile leakage. Five cases of duodenal papilla diverticulum, four cases of anomalous pancreaticobiliary ductal union, three cases of duodenal papillitis and one case of duodenal papilla carcinoma were cured with duodenoscopes therapy. 【Conclusion】 Periampullary diseases was an important reason for the persistent bile leakage through the fistulous tract after removal of cholecystostomy tube, abdominal pain and recurrence of gallstone after endoscopic invasive cholecystolithotomy with gallbladder.