经内镜超声引导肝胃造口术使用 22 号针的可行性。
Feasibility of endoscopic ultrasound-guided hepaticogastrostomy using a 22-gauge needle.
机构信息
Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan.
出版信息
Medicine (Baltimore). 2022 Nov 4;101(44):e31545. doi: 10.1097/MD.0000000000031545.
This study aimed to evaluate the feasibility of performing endoscopic ultrasound-guided hepaticogastrostomy using a 22-gauge fine-needle aspiration needle. This was a single-center retrospective study. Fourteen patients who underwent endoscopic ultrasound-guided hepaticogastrostomy with a 22-gauge fine-needle aspiration needle were examined. Fourteen eligible patients were included in this study. The age of patients ranged from 55 to 93 years, with a median of 76 years. Of patients with existing underlying diseases, there were 8 cases of pancreatic cancer (57.1%), 2 cases of metastatic liver tumor (14.3%), 2 cases of bile duct stones (14.3%), 1 case of hilar cholangiocarcinoma (7.1%), and 1 case of gallbladder cancer (7.1%). Regarding gastrointestinal anatomy, there were 11 cases (78.6%) of normal and 3 cases (21.4%) of gastric resection with Roux-en-Y. Reasons for endoscopic ultrasound-guided hepaticogastrostomy were duodenal obstruction in 7 cases (50.0%), surgically altered anatomy in 3 cases (21.4%), and 4 cases (28.6%) of failed endoscopic retrograde cholangiopancreatography. Technical success was achieved in 11 cases (78.6%). Subsequently, 11 cases of technical success were analyzed. There were 5 cases of puncturing B2 (45.5%). The puncture bile duct diameter ranged from 3.1 to 5.7 mm, with a median of 4.4 mm. endoscopic ultrasound-guided antegrade procedures was combined with endoscopic ultrasound-guided hepaticogastrostomy in 2 cases (18.2%). Clinical success was achieved in all the cases. The procedure time ranged from 15 to 93 minutes, with a median duration of 35 minutes. Regarding the type of stent placed in hepaticogastrostomy, a plastic stent was placed in 10 cases (90.9%) and a metal stent was placed in 1 case (9.1%). Early adverse events occurred in 4 cases (36.4%), and all of these cases developed biliary peritonitis, late adverse events occurred in 1 case (9.1%), this was biloma. A change to a 0.025-inch guidewire during the procedure was required in 8 cases (72.7%). Esophageal puncture was not performed. endoscopic ultrasound-guided hepaticogastrostomy using a 22-gauge fine-needle aspiration needle is effective. However, in 72.7% of the cases started using the 0.018-inch guidewire, the guidewire was exchanged for a 0.025-inch guidewire during procedure.
本研究旨在评估使用 22 号细针抽吸针进行内镜超声引导下肝胃吻合术的可行性。这是一项单中心回顾性研究。对 14 例行内镜超声引导下肝胃吻合术的患者进行了检查。本研究共纳入 14 例符合条件的患者。患者年龄 55 至 93 岁，中位年龄为 76 岁。在存在基础疾病的患者中，有 8 例胰腺癌（57.1%）、2 例转移性肝肿瘤（14.3%）、2 例胆管结石（14.3%）、1 例肝门部胆管癌（7.1%）和 1 例胆囊癌（7.1%）。关于胃肠道解剖结构，有 11 例（78.6%）为正常，3 例（21.4%）为胃切除术伴 Roux-en-Y。行内镜超声引导下肝胃吻合术的原因是十二指肠梗阻 7 例（50.0%）、手术改变解剖结构 3 例（21.4%）和内镜逆行胰胆管造影术失败 4 例（28.6%）。技术成功率为 11 例（78.6%）。随后对 11 例技术成功的患者进行分析。有 5 例穿刺 B2（45.5%）。穿刺胆管直径为 3.1 至 5.7mm，中位数为 4.4mm。2 例（18.2%）合并内镜超声引导下顺行操作。所有病例均获得临床成功。操作时间为 15 至 93 分钟，中位数为 35 分钟。关于肝胃吻合术中放置的支架类型，10 例（90.9%）放置塑料支架，1 例（9.1%）放置金属支架。早期不良事件发生 4 例（36.4%），均为胆漏，晚期不良事件发生 1 例（9.1%），为胆汁瘤。8 例（72.7%）在操作过程中需要更换为 0.025 英寸导丝。未进行食管穿刺。使用 22 号细针抽吸针进行内镜超声引导下肝胃吻合术是有效的。然而，在 72.7%的病例中，开始使用 0.018 英寸导丝，在操作过程中导丝更换为 0.025 英寸导丝。
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