超声内镜引导下胆道引流治疗手术所致解剖结构异常的胆道梗阻

Endoscopic ultrasound guided biliary drainage in patients with biliary obstruction and surgically altered anatomy

目的探讨超声内镜引导下胆道引流(EUS-BD)在外科手术致解剖结构异常的胆道梗阻患者中的应用及其价值。方法回顾性分析2016年1月至2018年1月浙江大学医学院附属杭州市第一人民医院33例外科手术致解剖结构异常的胆道梗阻患者,在ERCP不成功后改为超声内镜下胆道引流的临床资料。观察EUS-BD的操作成功率、临床成功率、并发症发生率及住院时间。结果 33例患者中31例均通过超声内镜穿刺成功。其中经胃穿刺14例,经十二指肠穿刺17例,行对接技术8例。操作成功率为93.9%。33例患者经过EUS-BD后黄疸消退28例,临床成功率84.9%。患者并发出血2例、胆管炎1例,均经保守治疗后改善,其并发症发生率9.1%。患者住院时间为(12.4±5.7) d。结论超声内镜引导下胆道引流创伤小、疗效好,可作为ERCP失败的外科手术致解剖结构异常的胆道梗阻的首选治疗。

Objective To evaluate the efficacy of endoscopic ultrasound guided biliary drainage (EUS-BD) in patients with biliary obstruction and surgically altered anatomies. Methods We collected data from 33 patients with biliary obstruction and surgically altered anatomies from January 2016 to January 2018 in Zhejiang University School of Medicine Affiliated Hangzhou First People’s Hospital who underwent EUS-guided biliary drainage after unsuccessful ERCP. The operation success rate, clinical success rate, complication rate, hospital stay were studied. Results Of 33 patients, 31 were successfully operated and stented using endoscopic ultrasound puncture: 14 patients through the stomach, 17 patients through the duodenum;8 patients by the rendezvous approach. The operation success rate was 93.9%. Of the 33 patients, 28 had a significant decrease in jaundice, with a clinical success rate of 84.9%. Complications consisted of 2 patients with bleeding and 1 patient with cholangitis. These patients improved after conservative treatment. The complications rate was 9.1%. The hospital stay was (12.4±5.7) d. Conclusion EUS-BD can be the first choice for patients with biliary obstruction and surgically altered anatomy after failed endoscopic retrograde cholangiography in centers with expertise in EUS-BD procedures.