超声内镜引导的胆总管十二指肠造瘘术的可行性研究  

Feasibility and safety of EUS-guided choledochoduodenostomy

作　　者：孙波[1] 胡冰[1] 吴军[1] 夏明星[1] 高道键[1] 王淑萍[1] 于凤海[1] 王书智[1] Sun Bo Hu Bing Wu Jun Xia Mingxing Gao Daojian Wang Shuping Yu Fenghai Wang Shuzhi.(Department of Endoscopy, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai 400438, Chin)

机构地区：[1]第二军医大学附属上海东方肝胆外科医院内镜科,上海200438

出　　处：《中华消化内镜杂志》2016年第11期769-773,共5页Chinese Journal of Digestive Endoscopy

基　　金：上海市医学领军人才项目（2015-83）

摘　　要：目的初步评估常规ERCP失败后行超声内镜引导下胆总管十二指肠造瘘术（EUS—CDS）的可行性与安全性。方法2016年4月至同年6月3例ERCP操作失败的低位恶性胆管梗阻患者改行EUS—CDS并置入双蕈式金属覆膜支架，评估治疗效果及术后短期并发症发生情况。结果3例患者（其中胰腺癌2例、胆管下段癌1例）均成功置入支架，平均操作时间为20．7min（18—25min）。术后1例患者出现十二指肠出血，经血管介入成功止血；所有患者术后血清胆红素及肝酶水平较术前显著下降并顺利出院。结论在有经验的内镜中心，对低位胆管梗阻患者，实施EUS—CDS是安全可行的，可作为常规ERCP失败后的补救措施。Objective To analyze the feasibility and safety of EUS-guided choledochoduodenostomy （EUS-CDS） when routine ERCP failed. Methods Data of 3 consecutive patients with malignant lower bile duct obstruction, who underwent EUS-CDS with dual mushroom type covered metal stents （DMCMSs） be- tween April 2016 and June 2016 after unsuccessful ERCP in a single center were retrospectively analysed. The treatment outcome and short-term complications were evaluated. Results EUS-CDSs were successfully performed in all 3 study patients （M/F 1/2, mean age 67.3, range 56-82） and DMCMSs were placed with a mean procedural time of 20. 7 min （ 18-25 min）. ERCP failure was due to lower common bile duct malignan- cy in 1 patient, and pancreatic cancer in 2 others. One patient developed duodenal bleeding after the proce- dure, which was successfully managed by radiological intervention. Significant reduction of serum bilirubin and liver enzyme level occurred in all 3 patients and they were all discharged. Conclusion EUS-CDS is a safe and feasible rescue method after unsuccessful ERCP at an experienced endoscopic center.

关 键 词：肠瘘 十二指肠造口术 腔内超声检查 支架 可行性研究 

分 类 号：R657.4[医药卫生—外科学] R445.1[医药卫生—临床医学]