Kianicka B, Díte P, Piskac P
Gastroenterologické oddelení II. interní kliniky Lékarské fakulty MU a FN u sv. Anny Brno.
Vnitr Lek. 2009 Nov;55(11):1043-50.
The aim of this retrospective study was to analyse diagnostic and therapeutic success of endoscopic retrograde cholangiopancreatography (ERCP) in our sample of patients following Billroth II gastric resection, where, due to significantly modified anatomic ratios, this surgery represents a specific and often extremely difficult technical problem when performing ERCP.
The sample was followed up for 13 years (November 1994-December 2007). The data on 112 patients after Billroth II gastric resection were assessed retrospectively; indications for ERCP included cholestasis in 92 patients, acute biliary pancreatitis in 12 patients, acute cholangitis in 6 patients and suspected bile leak following laparoscopic cholecystectomy (LCE) in 2 patients.
Cannulation success during ERCP in the 112 patients following Billroth II gastric resection was 90.2% (i.e. 101 of the 112 patients). Normal ERCP finding was recorded in 4 patients. The remaining 97 patients had pathological results on ERCP (choledocholitiasis was found in 78 patients, malignant biliary stenosis in 14, benign biliary stenosis in 3 a bile leak following LCE in 2). Endoscopic treatment was initiated immediately after diagnostic ERCP in all these 97 patients, the initial step was in all cases endoscopic papillotomy using one of the special papillotomes (diathermy wire). Overall, therapeutic ERCP was completely successful in 83 of the 97 patients (85.6% of 97) in whom the originally endoscopic treatment had been initiated.
ERCP following Billroth II gastric resection is, due to modified post-surgery anatomy, markedly more challenging then the conventional procedure. Availability of a variety of tools as well as, understandably, extensive experience and skill of an endoscopist are prerequisite to ERCP success in these patients. Correctly performed ERCP in patients following Billroth II gastric resection is a highly effective and safe method for diagnostics and, in particular, treatment of pancreatic-biliary diseases, in which similar success as under standard anatomic conditions can be achieved.
本回顾性研究旨在分析在我们接受毕罗Ⅱ式胃切除术的患者样本中，内镜逆行胰胆管造影术（ERCP）的诊断和治疗成功率。在这类患者中，由于解剖比例发生显著改变，进行ERCP时该手术代表了一个特殊且通常极具难度的技术问题。
该样本随访了13年（1994年11月至2007年12月）。对112例毕罗Ⅱ式胃切除术后患者的数据进行回顾性评估；ERCP的适应证包括92例胆汁淤积、12例急性胆源性胰腺炎、6例急性胆管炎以及2例腹腔镜胆囊切除术后（LCE）疑似胆漏。
112例毕罗Ⅱ式胃切除术后患者ERCP时的插管成功率为90.2%（即112例患者中的101例）。4例患者ERCP检查结果正常。其余97例患者ERCP有病理结果（78例发现胆总管结石，14例为恶性胆管狭窄，3例为良性胆管狭窄，2例为LCE后胆漏）。在所有这97例患者中，诊断性ERCP后立即开始内镜治疗，所有病例的初始步骤均为使用一种特殊的乳头切开刀（电凝丝）进行内镜乳头切开术。总体而言，在最初接受内镜治疗的97例患者中，83例（97例中的85.6%）治疗性ERCP完全成功。
由于术后解剖结构改变，毕罗Ⅱ式胃切除术后的ERCP比传统手术更具挑战性。各种工具的可用性以及内镜医师丰富的经验和技能，是这些患者ERCP成功的先决条件。在毕罗Ⅱ式胃切除术后患者中正确进行的ERCP是诊断尤其是治疗胰胆疾病的一种高效且安全的方法，可取得与标准解剖条件下相似的成功率。
