治疗性内镜逆行胰胆管造影术在胃大部切除术后合并胆总管结石中的应用  

The role of therapeutic endoscopic retrograde cholangiopancreatography in patients with bile common duct calculi and a previous Billroth Ⅱ anastomosis

作　　者：麻树人[1] 陈孝[1] 张宁[1] 常丽娅[1] 宫照杰[1] 杨琳[1] 赵云峰[1] 

机构地区：[1]沈阳军区总医院消化内镜中心,沈阳110016

出　　处：《中国实用内科杂志》2008年第2期128-129,132,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的探讨治疗性内镜逆行胰胆管造影术(ERCP)对胃大部切除BillrothⅡ吻合术后合并胆总管结石的治疗价值。方法对1999年5月至2007年8月就诊于沈阳军区总医院消化内镜中心经ERCP治疗的26例胃大部切除BillrothⅡ吻合术后合并胆总管结石患者的病例资料进行回顾性分析,以评价治疗性ERCP在该病中的应用价值。结果治疗性ERCP在胃大部切除BillrothⅡ吻合术后合并胆结石治疗中成功率为92.31%(24/26)。使用胆道支架加针形刀法切开十二指肠乳头11例(45.83%),球囊扩张法4例(16.67%),切开刀电切法5例(20.83%),未进行括约肌处理4例(16.67%)。结石完全清除19例,清除率为73.08%,取出部分结石后行内引流或外引流处理5例,单纯行鼻胆管外引流2例。术后轻中度发热2例,肠道穿孔1例,高淀粉酶血症2例,无胰腺炎发生。结论治疗性ERCP是治疗胃大部切除BillrothⅡ吻合术后合并胆总管结石的有效手段,但操作具有难度,可有一定的并发症,可在有技术条件的医院选择性开展。Objective To evaluate retrospectively the results of therapeutic ERCP applications to patients with bile common duct stones and a previous Billroth Ⅱ gastrectomy. Methods Out of the 3000 patients who underwent ERCP between May 1999 and Augest 2007 in Shenyang General Hospital of PLA ,26（0. 87% ）had bile common duct stones and a previous Billroth Ⅱ gastrectomy. The records of these 26 patients were reviewed. Details noted included therapeutic inter- ventions, causes of failure and complications. Results Of 26 patients success rate of endoscopic treatment was 92. 31% （24/26）. Needle-knife precut papillotomy after placement of a pancreatic duct stent was performed in 11 patients. Biliary sphincterotomy in 5 patients, papillary balloon dilation in 4 patients, and 4 patients didn＇t accepted any treatment for the biliary sphincter. Complete bile duct clearance was achieved in 19 patients, part of bile duct stones removed, and ENBD was performed in 5 patients. Two patients received a nasobiliary catheter without sphincterotomy for urgent biliary drainage. One case of afferent loop perforation（ 2% ）was repaired surgically. Conclusion Therapeutic ERCP is quite an effective and safe method for diagnosis and treatment in patients with bile common duct stones and a prior Billroth Ⅱ anastomosis, but it is difficult and may be with some amplications, so it should be selectively applied in some hospitals.

关 键 词：内镜逆行胰胆管造影术 胆总管结石 BILLROTH Ⅱ吻合术 

分 类 号：R5[医药卫生—内科学]