Su Bum Park, Hyung Wook Kim, Dae Hwan Kang, Cheol Woong Choi, Ki Tae Yoon, Mong Cho, Byeong Jun Song, Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do 626-770, South Korea.
World J Gastroenterol. 2013 Dec 28;19(48):9405-9. doi: 10.3748/wjg.v19.i48.9405.
To investigate the usefulness of a guide wire and triple lumen needle knife for removing stones in Billroth II (B-II) gastrectomy patients.
Endoscopic sphincterotomy in patients with B-II gastrectomy is challenging. We used a new guide wire technique involving sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy. This technique was performed in nine patients between August 2010 and June 2012. Sphincterotomy as described above was performed. Adequate sphincterotomy, successful stone removal, and complications were investigated prospectively.
Sphincterotomy by triple lumen needle knife using guide wire was successful in all nine patients. Sphincterotomy started towards the 4-5 o'clock direction and continued to the upper margin of the papillary roof. Complete stone removal in one session was achieved in all patients. There were no procedure related complications, such as bleeding, pancreatitis, or perforation.
In patients with B-II gastrectomy, guide wire using sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy seems to be an effective and safe procedure for the removal of common bile duct stones.
探讨导丝和三腔针形刀在毕Ⅱ式（B-II）胃切除术后取石中的应用价值。
B-II 式胃切除术后的内镜下括约肌切开术颇具挑战性。我们采用了一种新的导丝技术，通过前视内镜使用三腔针形刀进行括约肌切开术。该技术于 2010 年 8 月至 2012 年 6 月期间应用于 9 例患者。上述方法行括约肌切开术。前瞻性研究了括约肌切开术、结石取出成功率和并发症情况。
9 例患者均成功采用导丝三腔针形刀行括约肌切开术。括约肌切开术从 4-5 点钟方向开始，向乳头顶部的上缘延伸。所有患者均在一次治疗中成功取出全部结石。无与操作相关的并发症，如出血、胰腺炎或穿孔。
对于 B-II 式胃切除术后患者，采用前视内镜下导丝辅助三腔针形刀行括约肌切开术似乎是一种有效且安全的方法，可用于取出胆总管结石。
