应用十二指肠侧视镜治疗胰十二指肠切除术后梗阻性黄疸价值研究(附16例报告)

Conventional side-view duodenoscopy in the treatment of obstructive jaundice after pancreaticoduodenectomy:A report of 16 cases

目的探讨常规十二指肠侧视镜结合球囊引导进镜法应用于胰十二指肠切除术后病人ERCP的可行性。方法回顾性分析2009年1月至2013年12月上海交通大学医学院附属新华医院16例胰十二指肠切除术后梗阻性黄疸病人行ERCP的临床资料。进镜采用球囊辅助法,2例采用X线下远距离插管,分析其成功率与有效性。结果在球囊引导辅助下成功进入空肠输入袢14例,9例到达胆肠吻合口并成功实施胆道插管,2例通过远距离胆道插管成功,总体成功率为68.8%(11/16),2例发生消化道穿孔,1例因空肠袢过度扭曲无法进一步进镜。结论常规十二指肠镜结合球囊造影引导进镜法可用于胰十二指肠切除术后病人ERCP治疗,但风险高,需要有经验的医师操作。

Objective To investigate the feasibility of application of balloon-assisted endoscopic retrograde cholangiopancreatography （ERCP） through conventional side-view duodenoscopes in patients after pancreaticoduodenectomy. Methods The clinical data of 16 cases of obstructive jaundice patients after pancreaticoduodenectomy performed ERCP between January 2009 and December 2013 in Affiliated Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. All the cases were performed retrieval-balloon-assisted enterography. Among them, 2 cases were performed distant intubation under X-ray. The success rate and effectiveness were analyzed. Results In the guidance of balloon-assisted, the jejunum afferent loops were entered successfully in 14 cases. The biliary enteric anastomoses were reached in 9 cases with the successful implementation of biliary duct intubation. Long-distance bile duct intubation was performed successfully in 2 cases. The overall success rate was 68.80% （11/14）. Digestive tract perforation occurred in 2 cases. One case couldn＇t enter the jejunal loop further for excessive distortion. Conclusion The application of balloon-assisted ERCP through conventional side-view duodenoscopes in obstructive jaundice patients after pancreaticoduodenectomy is feasible. But the risk is high. The operation should be performed by experienced doctors.