短型单气囊小肠镜在胃切除Roux-en-Y吻合术后患者ERCP诊疗的初步应用体会

Preliminary Application of Short Single-balloon Enteroscopy in the Diagnosis and Treatment of ERCP in Patients after Roux-en-Y Gastrectomy

目的探讨短型单气囊小肠镜(sSBE)在胃切除Roux-en-Y吻合术后胆胰疾病患者经内镜逆行性胰胆管造影术(ERCP)诊疗中的初步应用体会。方法回顾性分析12例胃切除Roux-en-Y吻合术后胆胰疾病患者的临床资料,其中9例为全胃切除术后Roux-en-Y吻合,3例为远端胃大部切除术后Roux-en-Y吻合,分析采用短型单气囊小肠镜行ERCP诊疗的临床资料和过程,总结完成情况及并发症发生情况。结果12例胃切除Roux-en-Y吻合术后胆胰疾病患者(其中胆总管结石10例,壶腹部肿瘤伴梗阻性黄疸1例,胃癌术后肝门部淋巴结转移伴梗阻1例)成功到达乳头并完成操作9例(75.0%),3例未能到达乳头(25.0%),术后发生ERCP术后胰腺炎2例(22.2%),经内科治疗后痊愈,无穿孔、消化道出血、死亡等严重并发症发生。结论短型单气囊小肠镜应用在胃切除Roux-en-Y吻合术后患者ERCP诊疗中是安全和有效的,但操作时间总体较长,对操作者的技术要求较高,此类患者需结合具体病情选择合适的处理方法。

Objective To explore the preliminary application of short single-balloon enteroscopy(sSBE)in the diagnosis and treatment of ERCP in patients with pancreaticobiliary diseases after Roux-en-Y gastrectomy.Methods The clinical data and process of ERCP with short single-balloon enteroscopy in 12 patients with pancreaticobiliary diseases after Roux-en-Y gastrectomy(including Roux-en-Y anastomosis after total gastrectomy in 9 cases and Rouxen-Y gastrectomy after distal subtotal gastrectomy in 3 cases)were retrospectively analyzed,and the completion and complications were summarized.Results Twelve patients with pancreaticobiliary diseases after Roux-en-Y gastrectomy(including 10 cases of choledocholithiasis,1 case of ampullary tumor with obstructive jaundice,and 1 case of hilar lymph node metastasis with obstruction after gastric cancer surgery),9 cases(75.0%)successfully reached the papilla and completed the operation,3 cases failed to reach the papilla(25.0%),and 2 cases(22.2%)developed post-ERCP pancreatitis after surgery,which recovered after medical treatment without serious complications such as perforation,gastrointestinal bleeding,or death.Conclusions Short single-balloon enteroscopy is safe and effective in the diagnosis and treatment of ERCP in patients after Roux-en-Y gastrectomy,but the operation time is generally high and the technical requirements for the operator are high.Such patients needs to select the appropriate treatment method in combination with the specific condition.