CAJ | 학술논문

目的评价使用双腔前视胃镜对毕Ⅱ式胃空肠吻合术后胆胰疾病患者进行经内镜逆行胰胆管造影术(ERCP)治疗的疗效及安全性.方法回顾性总结46例使用双腔前视胃镜进行ERCP治疗的毕Ⅱ式胃空肠吻合术后胆胰疾病患者的临床资料,统计十二指肠乳头插管成功率、并发症发生情况和治疗情况.结果十二指肠乳头插管成功率为82.6％ (38/46),8例失败,其中6例因双腔前视胃镜无法进入输入袢找到十二指肠乳头而失败,2例因乳头插管困难而失败.38例插管成功者中,31例胆管结石者均成功取出结石,4例胆总管下端恶性梗阻者均成功置入胆管金属支架,3例十二指肠乳头良性狭窄者经气囊扩张后均成功置入鼻胆引流管;所有患者术后恢复良好,无一例发生出血、穿孔和术后胰腺炎等严重并发症.结论使用双腔前视胃镜对毕Ⅱ式胃空肠吻合术后胆胰疾病患者进行ERCP治疗,插管成功率较高,可顺利完成后续ERCP相关治疗,并且不会明显增加并发症发生率,具有较好的临床应用价值.
목적 평개사용쌍강전시위경대필Ⅱ식위공장문합술후담이질병환자진행경내경역행이담관조영술(ERCP)치료적료효급안전성.방법 회고성총결46례사용쌍강전시위경진행ERCP치료적필Ⅱ식위공장문합술후담이질병환자적림상자료,통계십이지장유두삽관성공솔、병발증발생정황화치료정황.결과 십이지장유두삽관성공솔위82.6％ (38/46),8례실패,기중6례인쌍강전시위경무법진입수입번조도십이지장유두이실패,2례인유두삽관곤난이실패.38례삽관성공자중,31례담관결석자균성공취출결석,4례담총관하단악성경조자균성공치입담관금속지가,3례십이지장유두량성협착자경기낭확장후균성공치입비담인류관;소유환자술후회복량호,무일례발생출혈、천공화술후이선염등엄중병발증.결론 사용쌍강전시위경대필Ⅱ식위공장문합술후담이질병환자진행ERCP치료,삽관성공솔교고,가순리완성후속ERCP상관치료,병차불회명현증가병발증발생솔,구유교호적림상응용개치.
Objective To evaluate the therapeutic effect and safety of forward-viewing,doublechannel endoscope in the process of ERCP in patients with bile duct diseases after Billroth-Ⅱ gastroenterostomy.Methods ERCP was applied to 46 patients with bile duct diseases using forward-viewing,doublechannel endoscope.All patients had the history of Billroth-Ⅱ gastroenterostomy.The success rate of selective cannulation,complication rate and the outcome of all the patients were recorded.Results The procedure succeeded in 38 patients with a success rate of 82.6％,and failed in 8.Of all the failing cases,the afferent loop couldn't be accessed in 6,failure in biliary cannulation in 2.Of 38 successful cases,bile duct stones were successfully removed in 31,metal stents placed for malignant bile duct obstruction in 4,and endoscopic balloon dilation for benign common bile duct stricture in 3.All patients recovered without complications of perforation,delayed bleeding or pancreatitis.Conclusion For patients with history of Billroth-Ⅱgastroenterostomy,ERCP with forward-viewing,double-channel endoscope yields to a higher success rate and lower complication rate.