徒手直接经口胆道镜在胆道疾病中的初步应用

Peroral direct cholangioscopy by freehand intubation using routine straight-view endoscope for diagnosis and therapy of bUiary diseases

目的探讨胃镜和鼻胃镜徒手直接经口胆道镜在胆道疾病诊治中的安全性及可行性。方法对5例胆管扩张患者先行ERCP，并根据十二指肠乳头开口大小决定是否进行扩张，扩张完成后退出十二指肠镜，然后采用胃镜或鼻胃镜进行徒手直接经口胆道镜检查，记录患者一般资料、ERCP诊治情况、胆道检查结果以及并发症发生情况。结果ERCP诊断胆总管结石2例、胆管内乳头状产黏蛋白肿瘤2例、胆管良性狭窄可回收金属支架置入术后1例，胆总管直径在1．2～2．4cm，有3例行乳头括约肌中切开后柱状气囊扩张，其余2例未行乳头括约肌切开和扩张。5例均顺利完成徒手直接经口胆道镜检查，其中使用胃镜1例、鼻胃镜2例、胃镜和鼻胃镜2例，进入胆总管下段1例、胆总管中上段4例。术后发生胆管炎1例，无操作相关死亡发生。结论应用胃镜或鼻胃镜徒手直接经口胆道镜检查是安全和可行的，在特定胆道疾病的诊治中可起到十分重要的作用。

Objective To evaluate the feasibility and safety of peroral direct cholangioscopy （PDCS） by freehand intubation using routine straight-view endoscope for diagnosis and therapy of biliary diseases. Methods Patients with bile duct dilation underwent standard ERCP and native papilla was dilated using EST and/or endoscopic papillary large balloon dilation, according to the size of the papilla. Then peroral direct cholangioscopy was performed by freehand intubation using routine straight-view endoscope. General data of patients, procedure of ERCP, diagnosis of PDCS and complications were recorded. Results A total of 5 patients underwent PDCS. Indications included common bile duct stones （ n = 2 ） , intraductal papillary neoplasm of bile buct （ n = 2 ） and benign biliary stricture after removable metal stent placement （ n = 1 ）. The diameter of common bile duct ranges from 1.2 cm to 2. 4 cm. EST or/and EPLBD was required in 3/5 patients to facilitate PDCS. Freehand PDCS intubation of the bile duct was successful in all procedures （ 1 case into distal common bile duct, 4 cases into proximal common bile duct）. Complications were cholangitis managed with intavenous antibiotics （ n = 1 ）. No procedure related death occurred. Conclusion Free- hand PDCS is technically feasible and safe, and may be clinically useful for diagnostic and therapeutic pur- poses in managing select biliary tract diseases.