Sofi Aijaz A, Tang Jianlin, Alastal Yaseen, Nawras Ali T
Department of Medicine, Division of Gastroenterology, University of Toledo Medical Center, Toledo, Ohio, USA.
Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA.
Gastrointest Endosc. 2014 Sep;80(3):511-5. doi: 10.1016/j.gie.2014.04.039. Epub 2014 Jun 11.
Bile duct occlusion secondary to inadvertent application of a surgical clip or suture usually is managed with endoscopic or surgical exploration.
To evaluate the safety and efficacy of a novel method of simultaneous endoscopic and laparoscopic approach in patients with acute iatrogenic bile duct obstruction.
Single arm study and single center design.
University medical center.
Three consecutive patients diagnosed with complete or near-complete obstruction of a bile duct after cholecystectomy were identified for inclusion.
Endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopy was performed simultaneously. Surgeon removes the surgical clips or suture from the bile duct with concurrent ERCP by endoscopist to assess and treat bile duct injury following resolution of the block.
Technical and clinical success rate and adverse events.
All of the patients were seen between 5 and 7 days after cholecystectomy. The diagnosis of obstructed bile duct was established by ERCP. The guidewire failed to negotiate across the obstruction in one of these patients. In another patient, a guidewire could be passed, but a biliary stent could not be deployed across the high-grade stricture. In a third patient, only a single biliary stent (7F × 11 cm) could be placed across the obstruction, with significant difficulty. In all the patients, simultaneous ERCP and laparoscopy were performed immediately to remove the surgical clips and/or sutures from the bile duct, followed by placement of biliary stents.
Small series.
The concurrent endoscopic and laparoscopic approach for the management of acute iatrogenic common bile duct obstruction is associated with rapid and complete recovery.
因手术夹或缝线意外应用导致的胆管阻塞通常采用内镜或手术探查进行处理。
评估一种新型的内镜与腹腔镜联合方法治疗急性医源性胆管梗阻患者的安全性和有效性。
单臂研究及单中心设计。
大学医学中心。
连续纳入3例胆囊切除术后诊断为胆管完全或近乎完全阻塞的患者。
同时进行内镜逆行胰胆管造影（ERCP）和腹腔镜检查。外科医生在内镜医师进行ERCP的同时从胆管中取出手术夹或缝线，以在梗阻解除后评估和治疗胆管损伤。
技术成功率、临床成功率及不良事件。
所有患者均在胆囊切除术后5至7天接受诊治。通过ERCP确诊胆管梗阻。其中1例患者的导丝未能通过梗阻部位。另一例患者，导丝可以通过，但无法在高度狭窄处放置胆管支架。第三例患者，仅能勉强放置一枚单根胆管支架（7F×11 cm）跨越梗阻部位。所有患者均立即同时进行ERCP和腹腔镜检查以从胆管中取出手术夹和/或缝线，随后放置胆管支架。
样本量小。
内镜与腹腔镜联合方法治疗急性医源性胆总管梗阻可使患者快速、完全康复。
