Artifon Everson L A, Couto Décio S, Navarro Alex
Gastroenterology Department, São Paulo University, Brazil.
Acta Gastroenterol Latinoam. 2009 Mar;39(1):19-23.
diagnostic and therapeutic ERCP in patients with Billroth II gastrectomy is a challenging procedure due to anatomic alterations. New accessories and techniques were developed in order to minimize these adversities.
a new technique for biliary access in patients with Billroth II gastrectomy.
In the period from February 2003 to August 2007, 257 ERCP presented Billroth II gastrectomy and choledocolithiasis. In 37 of these patients catheterization by conventional technique was not possible and they were submitted to the new technique.
after fistulotomy in order to access CBD, a 0.035-inch guidewire was passed followed by an 8-mm dilator biliary balloon which was settled in transpapillary position. Through the working channel the knedle-knife was passed which when positioned in front of the papilla allowed the section of the sphincter over the balloon inflated with contrast until waist disappearance on radioscopy.
of the 37 patients submitted to the new procedure six were excluded. Sixteen patients (61.6%) were female and fifteen (48.4%) male. Age ranged from 29 to 89 years with a mean of 62.3 years. All patients had jaundice by clinical and laboratory tests. Time of procedure varied from 18 to 48 minutes (30 minutes). Diameter of the bile duct was 4.5 to 12.8 mm (7.7 mm) presenting one to seven calculi. There were occurred six (19.3%) complications related to the procedure, three (9.7%) pancreatitis, two (6.4%) hemorrhages and one (3.2%) perforation. There were no procedure-related deaths.
success of this technique was 83.8% (31 of the 37 cases); therefore the technique is considered a safe and efficient method in patients with Billroth II and difficult duodenal papilla cannulation and it was previously attempted by means of conventional cannulation technique.
由于解剖结构改变，毕罗Ⅱ式胃切除术后患者的内镜逆行胰胆管造影术（ERCP）诊断及治疗具有挑战性。为将这些不利影响降至最低，人们研发了新的附件及技术。
探索一种用于毕罗Ⅱ式胃切除术后患者胆管通路的新技术。
2003年2月至2007年8月期间，257例接受ERCP检查的患者有毕罗Ⅱ式胃切除术及胆总管结石。其中37例患者无法通过传统技术进行插管，遂采用新技术。
为进入胆总管行瘘管切开术后，置入一根0.035英寸导丝，随后置入一个8毫米扩张球囊胆管，使其处于经乳头位置。通过工作通道插入针刀，将其置于乳头前方，在球囊内注入造影剂使其膨胀，直至在透视下腰部消失，从而切开括约肌。
37例接受新手术的患者中，6例被排除。16例患者（61.6%）为女性，15例（48.4%）为男性。年龄范围为29至89岁，平均62.3岁。所有患者经临床及实验室检查均有黄疸。手术时间为18至48分钟（平均30分钟）。胆管直径为4.5至12.8毫米（平均7.7毫米），有1至7枚结石。该手术发生6例（19.3%）并发症，3例（9.7%）胰腺炎，2例（6.4%）出血，1例（3.2%）穿孔。无手术相关死亡病例。
该技术成功率为83.8%（37例中的31例）；因此，对于毕罗Ⅱ式胃切除且十二指肠乳头插管困难的患者，该技术被认为是一种安全有效的方法，此前曾尝试通过传统插管技术进行操作。
