结肠镜和小肠镜辅助下经内镜逆行胰胆管造影术在Roux-en-Y吻合术后患者中的应用比较(含视频)

Comparison of endoscopic retrograde cholangiopancreatography assisted with colonoscope and enteroscopeinpatients withhistoryofRoux-en-Yanastomosis (withvideo)

目的比较标准结肠镜和单气囊小肠镜辅助下经内镜逆行胰胆管造影术(endoscopic retrogradecholangiopancreatography,ERCP)在Roux-en-Y吻合术后患者中的有效性及安全性。方法回顾性研究2017年1月-2020年12月就诊于南京医科大学附属杭州医院行标准结肠镜或单气囊小肠镜辅助下ERCP的70例Roux-en-Y术后胆道疾病患者资料,依据内镜使用不同,分为标准结肠镜组(n=43)与单气囊小肠镜组(n=27)。比较两组进镜成功率、插管成功率、ERCP成功率及并发症发生率。结果70例患者共行了81例次ERCP。标准结肠镜组和单气囊小肠镜组进镜成功率分别为91.8%(45/49)、78.1%(25/32),差异无统计学意义(x^(2)=2.04,P=0.153)。标准结肠镜组和单气囊小肠镜组原始乳头插管成功率分别为74.1%(20/27)和1/6,标准结肠镜组原始乳头插管成功率显著高于单气囊小肠镜组(P=0.016)。标准结肠镜组和单气囊小肠镜组ERCP成功率分别为75.5%(37/49)和59.4%(19/32),差异无统计学意义(x^(2)=2.36,P=0.124)。ERCP术后并发症发生率分别为4.1%(2/49)和9.4%(3/32),差异无统计学意义(x^(2)=0.25,P=0.620)。结论标准结肠镜和单气囊小肠镜辅助下ERCP在Roux-en-Y吻合术后患者中实施安全有效,标准结肠镜辅助下ERCP可成为Roux-en-Y吻合术后患者发生胆道疾病的一种内镜治疗方案。

Objective To compare the efficacy and safety of endoscopic retrograde cholangiopancreatography(ERCP)assisted with colonoscope and enteroscope in patients with history of Roux-en-Yanastomosis.Methods A retrospective study was performed on the data of 70 patients who underwent ERCP assisted with standard colonoscope or single balloon enteroscope after Roux-en-Y reconstruction in Hangzhou Hospital Afiliated to Nanjing Medical University from January 2017 to December 2020.Patients were divided into the standard colonoscopy group(n=43)and the single balloon enteroscopy group(n=27)according to endoscopy.The success rates of insertion,intubation and ERCP,and incidence of complications were compared.ResultsA total of 81 ERCP procedures were performed in 70 patients.The insertion success rates of the standard colonoscopy group and the single balloon enteroscopy group were 91.8%(45/49)and 78.1%(25/32),respectively,showing no significant difference(x^(2)=2.04,P=0.153).The success rates of primitive papilla intubation in the two groups were 74.1%(20/27)and 1/6,showing significant difference(P=0.016).The ERCP success rates of the standard colonoscopy group and the single balloon enteroscopy group were 75.5%(37/49)and 59.4%(19/32),showing no significant difference(x^(2)=2.36,P=0.124).The post operative complication incidences of the standard colonoscopy group and the single balloon enteroscopy group were 4.1%(2/49)and 9.4%(3/32),showing no significant difference(x^(2)=0.25,P=0.620).ConclusionERCP assisted with standard colonoscope and single balloon enteroscope is safe and effective in patients after Roux-en-Y anastomosis.Standard colonoscopic ERCP can become an endoscopy solution for patients with biliary tract disease after Roux-en-Y reconstruction.