SpyGlass内镜直视系统治疗内镜和外科手术治疗失败的困难胆管结石

SpyGlass direct visualization system in treatment of choledocholithiasis patients after treating failure through endoscopic and surgical approach

目的:评价SpyGlass内镜直视系统(SpyGlass DS)治疗内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)和外科手术失败困难胆管结石的有效性及安全性。方法:回顾性分析2020年1月至2021年12月瑞金医院外科8例病人,行SpyGlass DS联合ERCP直视碎石取石的临床资料,评估诊治效果以及不良事件发生率。病人均为困难胆管结石。7例ERCP取石失败,其中4例1次,1例5次,2例6次。1例外科手术治疗未成功。结果:8例共10次SpyGlass DS治疗,诊断和治疗均成功。4例(50%)1次治疗成功,余4例(50%)术后1周至4个月再次治疗成功。1例诊断胆总管结石合并胆管肿瘤,内镜成功取石后行外科手术治疗。术后病人轻微上腹痛2例次(20%),发热3例次(30%),高淀粉酶血症1例次(10%),肝功能异常4例次(40%),急性胆管炎1例次(10%)。所有症状轻微,对症处理后好转。未发生胰腺炎、消化道穿孔和出血等并发症。结论:对常规方法治疗失败的困难胆管结石,SpyGlass DS联合ERCP及碎石技术安全,诊断和治疗都获成功。

Objective To evaluate the efficacy and safety of SpyGlass direct visualization system(DS)in treatment of patients with difficult choledocholithiasis after removing failure through endoscopic retrograde cholangiopancreatography(ERCP)and surgical approach.Methods The clinical data of 8 patients with choledocholithiasis who had undergone lithotripsy with SpyGlass DS combined with ERCP in department of surgery Ruijin Hospital,from January 2020 to December 2021 were analyzed retrospectively.The diagnosis and treatment and adverse events incidence were evaluated.All cases were with difficult choledocholithiasis.Seven cases had removal stone failure of ERCP including 4 cases with 1 time,1 case with 5 times,and the other 2 cases with 6 times.One case had history of surgical treatment failure.Results A total of 8 cases received 10 times of Spyglass DS procedures with all cases successful visualization of bile duct stones and complete stone removal.Four cases(50%)underwent successful stone removal at the first procedure.The other 4 cases(50%)were successful stone removal after treatment again from 1 week to 4 months post procedures.One case was diagnosed both common bile duct stone and bile duct tumor and treated by surgery after endoscopy.There were 2 cases(20%)with slight epigastric pain,3 cases(30%)with fever,1 case(10%)with hyperamylasemia,4 cases(40%)with abnormal liver function and 1 case(10%)with acute cholangitis.All cases with symptom were mild and improved after treatment.No procedure-related pancreatitis,gastrointestinal perforation or massive hemorrhage was found.Conclusions SpyGlass DS with ERCP and lithotripsy would be effective and safe in diagnosis and treatment of the patients with difficult choledocholithiasis who had previous treatment failure by conventional methods.