超细胃镜作为经口胆道镜应用的临床初步研究  

The primary clinical study of peroral cholangioscopy by using an ultra-slim gastroscope

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

机构地区：[1]解放军第175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：《中华临床医师杂志（电子版）》2014年第8期78-81,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：南京军区医学科技创新经费资助项目(10MB017)

摘　　要：目的探讨超细胃镜作为经口胆道镜临床应用的安全性及应用价值。方法回顾分析7例患者超细胃镜作为经口胆道镜辅助内镜逆行胰胆管造影术(ERCP)胆总管取石治疗的临床资料。患者均为胆总管结石并扩张,行常规ERCP碎石、取出结石。单气囊小肠镜外套管前端气囊充气后固定于十二指肠球部,超细胃镜经小肠镜外套管沿胆管导丝进入胆总管,直视下清除胆总管残留小结石。结果采用胆管导丝引导超细胃镜成功进入胆总管2例,加用小肠镜外套管成功2例。这4例均在超细胃镜直视下成功清除胆总管残留碎石,其中1例活检证实合并胆总管下段癌。3例超细镜无法进入胆总管。发生胆漏1例,均无出血、胰腺炎、穿孔等其他并发症。结论超细胃镜作为经口胆道镜可以进入胆总管并完成活检等操作,但方法繁琐,成功率不高,仅适用于常规ERCP无法明确或治疗的胆总管病变。Objective To assess the clinical value and safety of ultra-slim gastroscope as peroral cholangioscopy. Methods There were 7 cases with dilated common bile duct and calculi in the retrospective study. Endoscopic retrograde cholangiography （ERCP） were undergone with assistance of ultra-slim gastroscope as peroral cholangioscopy. The calculi were broken to pieces and taken out with routine ERCP. Then, ultra-slim gastroscope as direct peroral cholangioscopy was inserted into the common bile duct and removed residual stones, with the guide of guidewire in bile duct and enteroscopy overtube-balloon assistance. Results With the guidewire in the biliary system, the ultra-slim gastroscope was inserted into the common bile duct successfully in 2 cases. With overtube-balloon-assistance, another 2 cases succeeded. Residual stones in the 4 cases were cleaned successfully by ultra-slim gastroscope as peroral cholangioscopy. One case of cholangiocarcinoma was confirmed by pathology biopsy with ultra-slim gastroscope. The ultra-slim gastroscope failed to insert into the common bile duct in the other 3 cases. As complication, one patient was found to be followed bile leakage. Bleeding, pancreatitis, perforation and other complications were not found in the series cases. Conclusions Ultra-slim gastroscope might insert into common bile tube and provide possible biopsy as peroral cholangioscopy. But the operation might be complicated with low success rate and only be recommended after failure of conventional ERCP techniques.

关 键 词：超细胃镜 经口胆道镜 胆总管结石 胰胆管造影术 内窥镜逆行 并发症 

分 类 号：R657.4[医药卫生—外科学]