Zou Xiao-Ping, Zhang Ming, Li Wen, Wu Yu-lin
Gastroenterology Department, Drum Tower Hospital Affiliated Medical College of Nanjing University, China.
Surg Laparosc Endosc Percutan Tech. 2011 Oct;21(5):e263-5. doi: 10.1097/SLE.0b013e318225d145.
We experienced a case of biliary intraductal papillary mucin-producing neoplasm diagnosed before operation by using an ultraslim upper endoscope without assistance of the guide wire. The patient, who had a Billroth II partial gastrectomy and partial resection of left liver lobe history, was admitted in our hospital because of jaundice. Imaging examination indicated dilatation of the intrahepatic and extrahepatic biliary ducts and pancreatic duct was normal. During the process of endoscopic retrograde cholangiography, a large amount of mucus was found extruded from the dilated orifice of papilla. A pediatric upper endoscope was inserted into the common bile duct and then into the left hepatic duct without the assistance of guide wire. The lesion was located and biopsy was taken. Final histology after surgery indicated the patient suffered from biliary intraductal papillary mucin-producing neoplasm. Slim upper endoscope maybe a useful instrument in some patients for peroral direct cholangioscopy, instead of the sophisticated mother-baby endoscope system.
我们遇到一例胆管内乳头状黏液性肿瘤患者，在未使用导丝辅助的情况下，通过超薄上消化道内镜在术前确诊。该患者有毕Ⅱ式胃大部切除术及左肝叶部分切除术史，因黄疸入院。影像学检查显示肝内、外胆管扩张，胰管正常。在内镜逆行胆管造影过程中，发现大量黏液从乳头扩张开口处挤出。在未使用导丝辅助的情况下，将小儿上消化道内镜插入胆总管，然后进入左肝管。定位病变并取活检。术后最终组织学检查表明患者患有胆管内乳头状黏液性肿瘤。对于一些患者，超薄上消化道内镜可能是经口直接胆管镜检查的有用器械，而非复杂的子母内镜系统。
