合并十二指肠狭窄患者实施经内镜逆行胰胆管造影术的策略

Therapeutic ERCP strategies in patients with duodenum stricture

目的探讨合并十二指肠狭窄患者实施ERCP诊疗的方法与策略。方法回顾性分析合并十二指肠狭窄患者的ERCP处理方法，观察内镜操作的成功率及并发症。结果7276例接受ERCP的患者中，合并十二指肠狭窄158例（2．17％），其中恶性肿瘤浸润肠壁120例，十二指肠良性狭窄38例。采用改变体位或导丝引导的方法顺利通过狭窄处完成ERCP及胆道引流96例，实施柱状水囊扩张术后完成ERCP33例，先放置十二指肠金属支架后行胆管引流4例，另有25例未能完成或放弃治疗。内镜操作成功率84．2％（133／158），术中有少量出血5例，未发生持续出血或穿孔等并发症。结论十二指肠狭窄患者仍有可能完成ERCP操作，轻度狭窄可通过改变体位或导丝引导帮助内镜通过，重度狭窄需采用水囊扩张或先留置肠道支架，根据局部病变情况循序应用以上方法实施内镜治疗仍是安全的，且成功率较高。

Objective To investigate the methods and strategies of therapeutic ERCP in patients with duodenum stricture. Methods Endoscopic procedure, success rate and complications in patients with duodenum stricture who underwent ERCP were retrospectively analyzed. Results In 7276 patients who underwent therapeutic ERCP, duodenum stricture was found in 158 （2.17%） , patients with malignant tumor infiltration in 120 and benign stricture in 38. The total success rate of ERCP and biliary drainage was 84. 2%, with posture change or guidewire leading method in 96 patients, stylolitic water sac dilation in 33and duodenum metal stent placement before biliary drainage in 4. The procedure was failed in 25 patients. Minor bleeding occurred in 5 patients and no major complication including massive bleeding or perforation was observed. Conclusion ERCP is safe, effective and feasible for patients with duodenum stricture, which can be performed by posture change or guidewire leading method in mild stricture, and stylolitic water sac dilation or duodenum metal stent placement in severe stricture.