胆道镜联合十二指肠镜治疗胆道术后良性胆总管末端狭窄8例报道

Combined duodenoscopy with choledochoscopy in benign terminal bile duct stricture after biliary exploration:a report of 8 cases

目的探讨胆道镜联合十二指肠镜治疗胆道术后良性胆总管末端狭窄的方法和效果。方法8例胆道术后良性胆总管末端狭窄病人,其中男性3例,女性5例,年龄42～78岁,平均年龄61.8岁。因难以直接行经胆道镜扩张或十二指肠镜乳头括约肌切开术(EST),所以先经胆道镜操作孔送斑马导丝至十二指肠,在导丝的引导下行EST来解决狭窄。结果术后5例出现一过性血、尿淀粉酶升高及发热,2例因症状缓解不明显而再次行十二指肠乳头切开,治疗过程均顺利,术前症状缓解,没有发生胆汁漏、十二指肠瘘、重症胰腺炎等严重并发症,近期随访无复发。结论胆道镜联合十二指肠镜治疗胆道术后胆管末端狭窄是创伤小、安全有效的方法。

Objective To explore the application of choledochoscope combined with duodenoscope for benign terminal common bile duct stricture of post-biliary exploration. Methods Eight post-biliary exploration patients, male 3, female 5, aged 42 - 78 years, mean age 61.8 years, suffered from benign distal biliary stricture were experienced difficulty with direct choledocbocopie dilatation or endoscopic sphincterotomy（EST）. In these patients the Zebra guidewire was inserted into duodenum through the side port, under the guidance of Zebra guidewire EST procedure was performed. Results Five patients experienced transient fever with elevation of blood and urine amylase after the procedure, and EST was repeated in two patients by alleviate still-present symptoms. The procedure was successful without complications eg. bile leak, duodenal fistula and severe acute pancreatitis. No recurrence was found in a recent follow-up. Conclusion After biliary exploration application of combined eholedochoscopy and duodenoscopy is a safe, effective and minimally-invasive approach for treating benign terminal bile duct stricture.