Schulz H J, Bertullies M, Drossel R
Oskar-Ziethen-Krankenhaus, Berlin-Lichtenberg.
Z Gastroenterol. 1998 Mar;36(3):225-31.
In the hands of an experienced endoscopist ERCP is an important method for the diagnosis of biliopancreatic diseases of Billroth II patients, but less effective than in nonoperated patients. Percutaneous procedures increase the success rate of nonoperative therapy. We report our own results of in 386 Billroth II patients: Success rate of diagnostic ERCP was 73.6% (284/386). Interventional endoscopy was performed in 192 patients: Successful EST was carried out in 93.6% (160/171), and complete extraction of bile duct stones was achieved in 74.8% (107/143), sufficient bile drainage was achieved by placement of transpapillary endoprostheses in 96.3% (79/82), while successful PTCD and percutaneous therapy were performed in 21 cases. Technical problems result from a long afferent loop, the upside-down position in the duodenal stump and difficult bile duct anatomy. We observed a complications rate of 3.6% (14/386) and a mortality of 0.5% (2/386). Our results are comparable with those in the literature, in which a similar number of difficult patients are included.
在经验丰富的内镜医师手中，内镜逆行胰胆管造影术（ERCP）是诊断毕Ⅱ式手术患者胆胰疾病的重要方法，但比未接受手术的患者效果要差。经皮操作可提高非手术治疗的成功率。我们报告了对386例毕Ⅱ式手术患者的研究结果：诊断性ERCP的成功率为73.6%（284/386）。对192例患者进行了介入性内镜检查：内镜下括约肌切开术（EST）的成功率为93.6%（160/171），胆管结石完全取出率为74.8%（107/143），通过放置经乳头内支架实现充分胆汁引流的比例为96.3%（79/82），同时对21例患者成功实施了经皮肝穿刺胆管引流术（PTCD）和经皮治疗。技术问题源于输入袢过长、十二指肠残端位置颠倒以及胆管解剖结构复杂。我们观察到并发症发生率为3.6%（14/386），死亡率为0.5%（2/386）。我们的结果与文献报道相当，文献中纳入的困难患者数量相近。
