毕罗Ⅱ式胃切除术后患者的内镜逆行胰胆管造影术：重点在于技术。

ERCP in post-Billroth II gastrectomy patients: emphasis on technique.

作者信息

Lin L F, Siauw C P, Ho K S, Tung J C

机构信息

Department of Internal Medicine, Shalu Tungs Memorial Hospital, Taichung, Taiwan, ROC.

出版信息

Am J Gastroenterol. 1999 Jan;94(1):144-8. doi: 10.1111/j.1572-0241.1999.00785.x.

DOI:10.1111/j.1572-0241.1999.00785.x

PMID:9934745

Abstract

OBJECTIVE

Endoscopic retrograde cholangiopancreatography (ERCP) in post-Billroth II (BII) gastrectomy is more difficult due to anatomical changes. The difficulties include entrance to the afferent loop and selective cannulation. Our aim here is to report the success rate and special manipulations and techniques of this procedure.

METHODS

A retrospective review of 56 ERCP procedures in post-BII gastrectomy patients was performed. There were 43 male and 13 female patients with a mean age of 63 yr (range, 32-78 yr). All cases were tried with forward-viewing endoscope first. Of the failed cases, 10 were retried by side-view duodenoscope. The entrance to the afferent loop was attempted by starting from the upper opening at the anastomosis site and, if this failed, then using the lower opening; presence of bile; and air-contrasted afferent loop under fluoroscopy. If failure of afferent loop entrance resulted, hand compression over the mid-abdomen, or polypectomy snare in the working channel of the endoscope, was tried. For failure of common bile duct cannulation with straight catheters, techniques of pushing the catheter against the duodenal wall and bending the tip of the endoscope or guidewire were used.

RESULTS

The success rate of afferent loop entrance was 76.7% (43 of 56 cases). The afferent loop was identified in the upper orifice of the anastomosis in 93% (40 of 43) of the cases. Eight cases of afferent loop entrance could be facilitated by hand compression, and three by polypectomy snare in the working channel of the endoscope. The success rate of ERCP cannulation in those successful afferent loop intubation cases was 81.3% (35/43 cases). Most of the selective common bile duct (CBD) cannulation was achieved by straight (new) catheter and an additional six cases were successful using the techniques mentioned. No serious complications were encountered, except three cases of submucosal hemorrhage.

CONCLUSION

The overall success rate of BII ERCP was 62.5% (35 of 56 cases). The special manipulations mentioned in BII ERCP can be helpful in certain cases.

摘要

目的

由于解剖结构改变，毕Ⅱ式（BII）胃切除术后的内镜逆行胰胆管造影（ERCP）操作难度更大。这些困难包括进入输入袢以及选择性插管。我们在此的目的是报告该操作的成功率以及特殊操作和技术。

方法

对56例BII胃切除术后患者的ERCP操作进行回顾性分析。其中男性43例，女性13例，平均年龄63岁（范围32 - 78岁）。所有病例首先尝试使用前视内镜。在失败的病例中，10例通过侧视十二指肠镜重新尝试。从吻合口的上部开口开始尝试进入输入袢，如果失败，则使用下部开口；观察胆汁情况；以及在透视下观察气钡双重造影的输入袢。如果输入袢进入失败，则尝试在中上腹进行手压，或在内镜工作通道中使用息肉切除圈套器。对于直导管无法成功插入胆总管的情况，采用将导管抵靠十二指肠壁以及弯曲内镜或导丝尖端的技术。

结果

输入袢进入的成功率为76.7%（56例中的43例）。93%（43例中的40例）的病例在吻合口的上部开口处识别出输入袢。8例输入袢进入可通过手压辅助，3例通过在内镜工作通道中使用息肉切除圈套器辅助。在那些成功进入输入袢插管的病例中，ERCP插管的成功率为81.3%（43例中的35例）。大多数选择性胆总管（CBD）插管是通过直（新）导管完成的，另外6例使用上述技术成功。除3例黏膜下出血外，未遇到严重并发症。