超细胃镜作为经口胆道镜在胆总管活检中的应用1例  

Ultra-slim gastroscope using as peroral cholangioscopy for forceps biopsy of the common bile duct: 1 case report

作　　者：苏军凯[1] 闵培 陈玲[1] 张鸣青[1] 唐庆林[1] 刘将[1] 李仙丽[1] 吕新芝[1] 

机构地区：[1]解放军第一七五医院厦门大学附属东南医院消化内科南京军区消化内镜中心,福建漳州363000

出　　处：《中国医药导报》2013年第33期117-119,共3页China Medical Herald

基　　金：解放军南京军区医学科技创新课题项目(编号10MB017)

摘　　要：目的提高对超细胃镜胆道镜用于胆总管疾病诊治的认识,并探讨其临床应用的安全性及效果。方法报道并分析1例胆总管下段占位并结石患者,超细胃镜作为胆道镜用于胆总管取石和活检,病理证实胆管癌,并复习国外相关文献。结果超细胃镜镜身较软,易在胃腔内打弯,镜身与乳头胆管成锐角,难以进入胆总管。应用胆管导丝及小肠镜外套管气囊固定于十二指肠球部,有助于超细胃镜进入胆总管。超细胃镜胆道镜可在直视下进行氩离子电凝、活检及激光液电碎石等诊疗。结论对于传统内镜下逆行胰胆管造影术无法确诊或治疗的病例,在胆管导丝及小肠镜外套管十二指肠球部固定辅助下,超细胃镜作为胆道镜进行诊疗是可行、有效的。Objective To enhance the cognition of ultrafine gastroscope choledochoscope used for common bile duct diseases treatment,and discuss the clinical value and result.Methods 1 case with dilated common bile duct combined with calculi and carcinorma were analyzed retrospectively.Ultraslim gastroscope using as peroral cholangioscopy was performed for assisting ERCP to clean broken choledocholithiasis and forceps biopsy.Pathology confirmed bile duct carcinoma.And foreign related literatures were reviewed.Results Ultra-slim gastroscope could not be inserted into the common bile duct,because the scope was soft and loop formation during advancement and little accessible angle to the papilla.With the guidewire in the biliary system and overtube-balloon assistance,the ultra-slim gastroscope was inserted into the common bile duct successfully.Under direct visualization of the intraductal lesion,argon plasma coagulation,forceps biopsy or laser lithotripsy could be performed.Conclusion With guidewire in bile system and duodenal balloon-assistance,direct cholangioscopy with an ultrathin endoscope is sufficiently feasible and may be useful as an alternative technique in cases that elude successfully diagnosis and therapy with conventional ERCP.

关 键 词：胆总管 超细胃镜 经口胆道镜 活检 

分 类 号：R575.62[医药卫生—消化系统]