CAJ | 학술논문

目的探讨胆道镜下高频电切治疗胆肠吻合术后吻合口狭窄的疗效及安全性. 方法回顾性分析2011年12月至2013年12月我科采用胆道镜下高频电切治疗13例胆肠吻合术后吻合口狭窄患者的临床资料.术中胆道镜直视下观察及镜下造影证实患者胆肠吻合口狭窄,从胆道镜器械孔插入高频针状电切刀,电切刀头进入吻合口内将吻合口处组织切开.结果 4例患者直接实施胆道镜下高频电切术,6例患者因结石堵塞肝门部胆管致球囊扩张导管置管失败而行电切术,3例患者因球囊扩张后膜状狭窄未解除而行电切术;电切术平均操作时间为13.5 min(5～25 min),切开过程中发生吻合口渗血3例,采取针状刀高频电凝成功止血,未发生肠漏、再出血等并发症;电切术后6例患者因存在胆肠吻合口相对狭窄,再行球囊扩张术;所有患者均取净肝内外胆管结石并放置支撑管.随访13例,时间1～4年,术后吻合口狭窄复发3例,采取经皮肝穿刺后持续性球囊扩张6个月后解除.结论胆道镜下高频电切术是治疗胆肠吻合口狭窄的一种简单、安全、有效的方法,尤其适用于球囊导管扩张失败患者.
목적 탐토담도경하고빈전절치료담장문합술후문합구협착적료효급안전성. 방법 회고성분석2011년12월지2013년12월아과채용담도경하고빈전절치료13례담장문합술후문합구협착환자적림상자료.술중담도경직시하관찰급경하조영증실환자담장문합구협착,종담도경기계공삽입고빈침상전절도,전절도두진입문합구내장문합구처조직절개.결과 4례환자직접실시담도경하고빈전절술,6례환자인결석도새간문부담관치구낭확장도관치관실패이행전절술,3례환자인구낭확장후막상협착미해제이행전절술;전절술평균조작시간위13.5 min(5～25 min),절개과정중발생문합구삼혈3례,채취침상도고빈전응성공지혈,미발생장루、재출혈등병발증;전절술후6례환자인존재담장문합구상대협착,재행구낭확장술;소유환자균취정간내외담관결석병방치지탱관.수방13례,시간1～4년,술후문합구협착복발3례,채취경피간천자후지속성구낭확장6개월후해제.결론 담도경하고빈전절술시치료담장문합구협착적일충간단、안전、유효적방법,우기괄용우구낭도관확장실패환자.
Objective To investigate the efficacy and safety of endoscopic high frequency electrotomy for bile duct anastomotic stricture after choledochojejunostomy.Method The clinical data of 13 cases of bile duct anastomotic strictures after choledochojejunostomy from December 2011 to December 2013 were retrospectively analyzed.After bile duct anastomotic stricture was confirmed with choledochoscope and cholangiography,a high-frequency needlelike electric knife was inserted into the anastomotic stoma from the hole of choledochoscope to cut the tissue around the stoma.Result 4 cases received endoscopic high frequency electrotomy.6 cases received electrotomy after a failure of balloon dilatation for stones blocking the hilar bile duct.3 cases received electrotomy for unsolved membranous stenosis after balloon dilation.The average operating time of electrotomy was 13.5 minutes (range,5-25 minutes).anastomotic stoma tissue bleeding occurred in 3 cases,which were cured with endoscopic high frequency electric cautery.6 cases received balloon dilatation for relative anastomotic stricture.Support tubes were placed until there was no residual stone.13 cases were followed up for 1-4 years,anastomotic stricture recurred in 3 cases and cured by percutaneously persistent balloon dilatation for 6 months.Conclusions Endoscopic high frequency electrotomy is a simple,safe and effective method for bile duct anastomotic stricture after choledochojejunostomy.It is especially suitable for balloon dilatation failure patients.