CAJ | 학술논문

目的：探讨超细胃镜作为经口胆道镜临床应用的安全性及应用价值。方法回顾分析7例患者超细胃镜作为经口胆道镜辅助内镜逆行胰胆管造影术（ERCP）胆总管取石治疗的临床资料。患者均为胆总管结石并扩张，行常规ERCP 碎石、取出结石。单气囊小肠镜外套管前端气囊充气后固定于十二指肠球部，超细胃镜经小肠镜外套管沿胆管导丝进入胆总管，直视下清除胆总管残留小结石。结果采用胆管导丝引导超细胃镜成功进入胆总管2例，加用小肠镜外套管成功2例。这4例均在超细胃镜直视下成功清除胆总管残留碎石，其中1例活检证实合并胆总管下段癌。3例超细镜无法进入胆总管。发生胆漏1例，均无出血、胰腺炎、穿孔等其他并发症。结论超细胃镜作为经口胆道镜可以进入胆总管并完成活检等操作，但方法繁琐，成功率不高，仅适用于常规ERCP无法明确或治疗的胆总管病变。
목적：탐토초세위경작위경구담도경림상응용적안전성급응용개치。방법회고분석7례환자초세위경작위경구담도경보조내경역행이담관조영술（ERCP）담총관취석치료적림상자료。환자균위담총관결석병확장，행상규ERCP 쇄석、취출결석。단기낭소장경외투관전단기낭충기후고정우십이지장구부，초세위경경소장경외투관연담관도사진입담총관，직시하청제담총관잔류소결석。결과채용담관도사인도초세위경성공진입담총관2례，가용소장경외투관성공2례。저4례균재초세위경직시하성공청제담총관잔류쇄석，기중1례활검증실합병담총관하단암。3례초세경무법진입담총관。발생담루1례，균무출혈、이선염、천공등기타병발증。결론초세위경작위경구담도경가이진입담총관병완성활검등조작，단방법번쇄，성공솔불고，부괄용우상규ERCP무법명학혹치료적담총관병변。
Objective To assess the clinical value and safety of ultra-slim gastroscope as peroral cholangioscopy. Methods There were 7 cases with dilated common bile duct and calculi in the retrospective study. Endoscopic retrograde cholangiography (ERCP) were undergone with assistance of ultra-slim gastroscope as peroral cholangioscopy. The calculi were broken to pieces and taken out with routine ERCP. Then, ultra-slim gastroscope as direct peroral cholangioscopy was inserted into the common bile duct and removed residual stones, with the guide of guidewire in bile duct and enteroscopy overtube-balloon assistance. Results With the guidewire in the biliary system, the ultra-slim gastroscope was inserted into the common bile duct successfully in 2 cases. With overtube-balloon-assistance, another 2 cases succeeded. Residual stones in the 4 cases were cleaned successfully by ultra-slim gastroscope as peroral cholangioscopy. One case of cholangiocarcinoma was confirmed by pathology biopsy with ultra-slim gastroscope. The ultra-slim gastroscope failed to insert into the common bile duct in the other 3 cases. As complication, one patient was found to be followed bile leakage. Bleeding, pancreatitis, perforation and other complications were not found in the series cases. Conclusions Ultra-slim gastroscope might insert into common bile tube and provide possible biopsy as peroral cholangioscopy. But the operation might be complicated with low success rate and only be recommended after failure of conventional ERCP techniques.