Matsumoto Kazuyuki, Tsutsumi Koichiro, Kato Hironari, Akimoto Yutaka, Uchida Daisuke, Tomoda Takeshi, Yamamoto Naoki, Noma Yasuhiro, Horiguchi Shigeru, Okada Hiroyuki, Yamamoto Kazuhide
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan.
Surg Endosc. 2016 Mar;30(3):1249-54. doi: 10.1007/s00464-015-4323-6. Epub 2015 Jun 27.
Hepatolithiasis is a postoperative complication of hepaticojejunostomy (HJ) performed for various pancreatobiliary diseases. Hepatolithiasis can cause repeated cholangitis. Complete stone removal and bile stasis elimination are therefore necessary. Here, we evaluated the effectiveness of peroral direct cholangioscopy (PDCS) using an ultraslim endoscope for treating hepatolithiasis in HJ patients.
We studied 14 patients with hepatolithiasis who underwent bowel reconstruction with HJ between April 2012 and May 2014. Diagnostic and therapeutic endoscopic retrograde cholangiography using a short double-balloon enteroscope (DBE) was initially performed. Following stone removal, the DBE was exchanged for an ultraslim endoscope through the balloon overtube for PDCS.
The success rate of PDCS procedure was 85.7% (12/14). In 5 of 12 (41.7%) patients with successful PDCS, the residual stones were detected and removed completely using a 5-Fr basket catheter and suction after normal saline irrigation. In the remaining 7 (58.3%) patients, no residual stone was detected. The median procedure time was 14 min (range 8-36) with no serious postoperative complications. The median follow-up time after PDCS was 21 months (range 5-26), and only 1 patient (8.3%) had IHBD stone recurrence with an anastomotic stricture.
PDCS using an ultraslim endoscope appears to be useful for detecting and removing residual stones following hepatolithiasis treatment using a DBE. The combined use of a DBE and PDCS may reduce the risk of hepatolithiasis recurrence in HJ patients.
肝内胆管结石是因各种胰胆疾病行肝空肠吻合术（HJ）后的一种术后并发症。肝内胆管结石可导致反复胆管炎。因此，彻底清除结石和消除胆汁淤积是必要的。在此，我们评估了使用超薄内镜经口直接胆管镜检查（PDCS）治疗HJ患者肝内胆管结石的有效性。
我们研究了2012年4月至2014年5月间接受HJ肠重建的14例肝内胆管结石患者。最初使用短双气囊小肠镜（DBE）进行诊断性和治疗性内镜逆行胆管造影。结石清除后，通过球囊外套管将DBE换成超薄内镜进行PDCS。
PDCS手术成功率为85.7%（12/14）。在12例PDCS成功的患者中，有5例（41.7%）在生理盐水冲洗后，使用5Fr网篮导管和吸引装置检测并完全清除了残留结石。其余7例（58.3%）患者未检测到残留结石。手术中位时间为14分钟（范围8 - 36分钟），无严重术后并发症。PDCS后的中位随访时间为21个月（范围5 - 26个月），只有1例患者（8.3%）出现肝内胆管结石复发并伴有吻合口狭窄。
使用超薄内镜的PDCS似乎有助于在使用DBE治疗肝内胆管结石后检测和清除残留结石。DBE和PDCS联合使用可能降低HJ患者肝内胆管结石复发的风险。
