经腹壁空肠造瘘行ERCP在消化道重建患者中的临床应用  

Therapeutic transjejunal ERCP for patients with digestive tract reconstruction

作　　者：张迎春[1] 麻树人[1] 杨卓[1] 高飞[1] 高峰[1] 李顺明 程广明[2] 金红旭[3] 刘宝军[4] 

机构地区：[1]沈阳军区总医院内窥镜科,沈阳110016 [2]沈阳军区总医院肝胆外科,沈阳110016 [3]沈阳军区总医院急诊科,沈阳110016 [4]沈阳军区总医院医务部,沈阳110016

出　　处：《中华消化内镜杂志》2014年第1期33-36,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨消化道重建患者经腹壁空肠造瘘行ERCP诊疗的疗效及安全性。方法回顾性分析22例经腹壁空肠造瘘行ERCP诊疗的消化道重建患者的疗效及并发症发生情况。结果22例均一次性完成经腹壁空肠造瘘，其中21例（95．5％）成功完成ERCP诊疗，内镜通过瘘口到达乳头或胆肠吻合口处的时间为6—34min，平均为18．4min；另外1例失败。ERCP诊断吻合口狭窄10例、肿瘤复发8例、胆总管结石1例、内支架堵塞1例，1例未见明显异常。置入塑料胆道内支架9例，置入金属胆道支架7例，更换塑料内支架1例，取石1例，仅行柱状球囊扩张2例。术后并发早期切口感染4例，并发胆道感染1例，并发肠瘘1例。结论对于消化道重建患者经腹壁空肠造瘘行ERCP是一种安全、有效、微创的治疗方法，可以在临床上推广使用。Objective To investigate the effectiveness and safety of jejunostomy ERCP via the ab-dominal wall in patients with digestive tract reconstruction. Methods Data of 22 patients with digestive tract reconstruction, who underwent ERCP by jejunostomy, were retrospectively analyzed for effectiveness and complications. Results Jejunostomy through the abdominal wall was eompleted in all patients. ERCP was successfully completed in 21 patients, where the duodenal papilla or anastomotic stoma were reached, and the time was 6 to 34 minutes, mean 18.4 minutes. It failed in one case and the success rate was 95.5%. Under endoscopy, anastomotic stenosis was diagnosed in 10 cases, tumor recurrence in 8 cases, choledocholithiasis in 1 case, stent blockage in 1 case, no abnormality was seen in 1 case. Plastic stenting was performed in 9 patients, metal stenting in 7 patients, replacement plastic stent in 1 patient, stone remov-al in 1 patient, cylindrical balloon dilation in 2 patients. Post - ERCP complications included 4 cases of inci-sional infection, 1 biliary tract infection and 1 intestinal fistula. Conclusion Jejunostomy ERCP through the abdominal wall in patients with digestive tract reconstruction is safe, effective and minimally invasive, which can be applied to clinical practice.

关 键 词：胰胆管造影术 内镜逆行 消化道重建 空肠造瘘术 

分 类 号：R57[医药卫生—消化系统]