经皮经肝胆道镜检查与经口短双气囊小肠镜检查对肝空肠吻合术后胆管结石治疗方法的比较评估
A comparative evaluation of treatment methods for bile duct stones after hepaticojejunostomy between percutaneous transhepatic cholangioscopy and peroral, short double-balloon enteroscopy.
作者信息
Tsutsumi Koichiro, Kato Hironari, Yabe Shuntaro, Mizukawa Sho, Seki Hiroyuki, Akimoto Yutaka, Uchida Daisuke, Matsumoto Kazuyuki, Tomoda Takeshi, Yamamoto Naoki, Horiguchi Shigeru, Kawamoto Hirofumi, Okada Hiroyuki
机构信息
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
出版信息
Therap Adv Gastroenterol. 2017 Jan;10(1):54-67. doi: 10.1177/1756283X16674633. Epub 2016 Oct 25.
BACKGROUND
Bile duct stones after hepaticojejunostomy are considered a troublesome adverse event. Although percutaneous transhepatic procedures using a cholangioscopy is performed to treat these bile duct stones, a peroral endoscopic procedure using a short, double-balloon enteroscope (sDBE) is an alternative. This study aimed to compare the immediate and long-term outcomes of both treatments for bile duct stones in patients who underwent prior hepaticojejunostomy.
METHODS
Between October 2001 and May 2013, 40 consecutive patients were treated for bile duct stones after hepaticojejunostomy at a tertiary care hospital. Initial success with biliary access, biliary intervention-related technical success, clinical success, adverse events, hospitalization duration, and stone-free survival were retrospectively evaluated.
RESULTS
The initial success rates for biliary access were 100% (8/8) with percutaneous transhepatic cholangioscopy (PTCS) and 91% (29/32) with sDBE. In three patients in whom biliary access during initial sDBE failed, successful access with subsequent PTCS was achieved, and biliary intervention-related technical success and clinical success were eventually achieved in all 40 patients. The rate of adverse events was significantly lower with sDBE than with PTCS (10% 45%; = 0.025). The median hospitalization duration for complete stone clearance was significantly shorter with sDBE than with PTCS (10 35 days; < 0.001). During the median 7.2 year or 3.1 year follow up, the probabilities of being stone-free at 1, 2, and 3 years were 100%, 73%, and 64% for PTCS and 85%, 65%, and 59% for sDBE, respectively ( = 0.919).
CONCLUSIONS
sDBE was useful, with few adverse events and short hospitalization; therefore, experienced endoscopists can consider it as first-line treatment for bile duct stones in patients with prior hepaticojejunostomy.
背景
肝空肠吻合术后胆管结石被认为是一种棘手的不良事件。尽管采用经皮经肝胆道镜检查的经皮肝穿刺手术用于治疗这些胆管结石，但使用短型双气囊小肠镜（sDBE）的经口内镜手术是一种替代方法。本研究旨在比较既往接受过肝空肠吻合术的患者中两种胆管结石治疗方法的近期和长期疗效。
方法
2001年10月至2013年5月期间，一家三级医疗中心连续40例患者接受了肝空肠吻合术后胆管结石治疗。对胆道通路建立的初始成功率、胆道介入相关技术成功率、临床成功率、不良事件、住院时间和无结石生存率进行回顾性评估。
结果
经皮经肝胆道镜检查（PTCS）的胆道通路建立初始成功率为100%（8/8），sDBE为91%（29/32）。在3例初始sDBE时胆道通路建立失败的患者中，随后通过PTCS成功建立了通路，所有40例患者最终均实现了胆道介入相关技术成功和临床成功。sDBE的不良事件发生率显著低于PTCS（10%对45%；P = 0.025）。sDBE完全清除结石的中位住院时间显著短于PTCS（10天对35天；P < 0.001）。在中位7.2年或3.1年的随访期间，PTCS在1年、2年和3年时无结石的概率分别为100%、73%和64%，sDBE分别为85%、65%和59%（P = 0.919）。
结论
sDBE有效，不良事件少且住院时间短；因此，经验丰富的内镜医师可将其视为既往接受过肝空肠吻合术患者胆管结石的一线治疗方法。
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