直接经口胆胰管镜检查使用超细内镜发现残余胆总管结石。
Residual common bile duct stones on direct peroral cholangioscopy using ultraslim endoscope.
机构信息
Department of Gastroenterology and Hepatology, Division of Digestive Therapeutic Endoscopy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
出版信息
World J Gastroenterol. 2013 Aug 14;19(30):4966-72. doi: 10.3748/wjg.v19.i30.4966.
AIM
To detect and manage residual common bile duct (CBD) stones using ultraslim endoscopic peroral cholangioscopy (POC) after a negative balloon-occluded cholangiography.
METHODS
From March 2011 to December 2011, a cohort of 22 patients with CBD stones who underwent both endoscopic retrograde cholangiography (ERC) and direct POC were prospectively enrolled in this study. Those patients who were younger than 20 years of age, pregnant, critically ill, or unable to provide informed consent for direct POC, as well as those with concomitant gallbladder stones or CBD with diameters less than 10 mm were excluded. Direct POC using an ultraslim endoscope with an overtube balloon-assisted technique was carried out immediately after a negative balloon-occluded cholangiography was obtained.
RESULTS
The ultraslim endoscope was able to be advanced to the hepatic hilum or the intrahepatic bile duct (IHD) in 8 patients (36.4%), to the extrahepatic bile duct where the hilum could be visualized in 10 patients (45.5%), and to the distal CBD where the hilum could not be visualized in 4 patients (18.2%). The procedure time of the diagnostic POC was 8.2 ± 2.9 min (range, 5-18 min). Residual CBD stones were found in 5 (22.7%) of the patients. There was one residual stone each in 3 of the patients, three in 1 patient, and more than five in 1 patient. The diameter of the residual stones ranged from 2-5 mm. In 2 of the patients, the residual stones were successfully extracted using either a retrieval balloon catheter (n = 1) or a basket catheter (n = 1) under direct endoscopic control. In the remaining 3 patients, the residual stones were removed using an irrigation and suction method under direct endoscopic visualization. There were no serious procedure-related complications, such as bleeding, pancreatitis, biliary tract infection, or perforation, in this study.
CONCLUSION
Direct POC using an ultraslim endoscope appears to be a useful tool for both detecting and treating residual CBD stones after conventional ERC.
目的
在球囊阻塞胆管造影阴性后，使用超细经口胆道镜（POC）检测和处理残余胆总管（CBD）结石。
方法
2011 年 3 月至 2011 年 12 月，前瞻性纳入 22 例 CBD 结石患者，这些患者均接受了内镜逆行胰胆管造影（ERC）和直接 POC。年龄小于 20 岁、妊娠、病危或无法对直接 POC 提供知情同意、同时伴有胆囊结石或 CBD 直径小于 10mm 的患者被排除在外。在获得球囊阻塞胆管造影阴性后，立即使用带外套管球囊辅助技术的超细内镜进行直接 POC。
结果
8 例（36.4%）患者的超细内镜能够进入肝门或肝内胆管（IHD），10 例（45.5%）患者的内镜进入肝外胆管并能观察到肝门，4 例（18.2%）患者的内镜进入远端 CBD 但不能观察到肝门。诊断性 POC 的操作时间为 8.2±2.9 分钟（范围：5-18 分钟）。5 例（22.7%）患者发现残余 CBD 结石。3 例患者各有 1 枚残余结石，1 例患者有 3 枚，1 例患者有超过 5 枚。残余结石的直径为 2-5mm。在 2 例患者中，通过直接内镜控制，使用取石球囊导管（n=1）或篮状取石导管（n=1）成功取出残余结石。在其余 3 例患者中，通过直接内镜可视化下冲洗和抽吸的方法取出残余结石。本研究中无严重的与操作相关的并发症，如出血、胰腺炎、胆道感染或穿孔。
结论
使用超细内镜进行直接 POC 似乎是一种有用的工具，可用于检测和处理常规 ERC 后的残余 CBD 结石。
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