Tang Bing-Xi, Li Xin-Li, Wei Ning, Tao Tao
Department of Gastroenterology, Zibo Central Hospital, Zibo 255000, Shandong Province, China.
Laboratory Section, Zibo Central Hospital, Zibo 255000, Shandong Province, China.
World J Gastrointest Surg. 2023 Jun 27;15(6):1211-1215. doi: 10.4240/wjgs.v15.i6.1211.
Difficult bile duct intubation is a big challenge for endoscopists during endoscopic retrograde cholangiopancreatography (ERCP) procedure. We report a case of percutaneous transhepatic cholangial drainage (PTCD)-guided methylene blue for fistulotomy using dual-knife for bile duct intubation.
A 50-year-old male patient had developed obstructive jaundice, and ERCP procedure need to be performed to treat the obstructive jaundice. But intubation cannot be performed if the duodenal papilla cannot be identified because of previous surgery for a perforated descending duodenal diverticulum. We used PTCD-guided methylene blue to identify the intramural common bile duct before dual-knife fistulotomy, and bile duct intubation was successfully completed.
The method that combing methylene blue and dual-knife fistulotomy to achieve bile duct intubation during difficult ERCP is safe and effective.
在经内镜逆行胰胆管造影（ERCP）手术过程中，胆管插管困难是内镜医师面临的一大挑战。我们报告一例经皮经肝胆管引流（PTCD）引导下使用双针刀行瘘管切开术并注入亚甲蓝以实现胆管插管的病例。
一名50岁男性患者出现梗阻性黄疸，需要进行ERCP手术治疗梗阻性黄疸。但由于既往因十二指肠降部憩室穿孔进行过手术，无法识别十二指肠乳头，故无法进行插管。我们在双针刀瘘管切开术前使用PTCD引导下的亚甲蓝来识别壁内胆总管，成功完成了胆管插管。
在困难的ERCP手术中，联合使用亚甲蓝和双针刀瘘管切开术实现胆管插管的方法是安全有效的。
