透明帽辅助胃镜在胃大部切除术后合并胆管疾病患者逆行性胰胆管造影术中的临床应用  

Clinical application of transparent cap gastroscope in the Billroth Ⅱprocedure after subtotal gastrectomy with bile duct disease in patients with ERCP

作　　者：阮巍山[1] 岑川[1] 刘烨琳[1] 高燕萍[1] 

机构地区：[1]中山市人民医院消化内科,广东省中山528400

出　　处：《中国基层医药》2017年第14期2113-2116,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的 探讨透明帽辅助胃镜在胃大部切除术后合并胆管疾病患者经内镜逆行性胰胆管造影术（ERCP）的临床应用价值.方法 选取20例毕罗Ⅱ式胃大部切除术后合并胆管疾病患者作为研究对象,选择透明帽辅助胃镜ERCP,插管成功者接受内镜下十二指肠乳头括约肌切开术（EST）和/或经内镜鼻胆管引流术（ENBD）、经内镜乳头气囊扩张术（EPBD）、经内镜胆管金属支架内引流术（EMBE）、经内镜胆管内引流术（ERBD）等治疗.结果 20例患者毕罗Ⅱ式胃大部切除术后插管造影全部成功,成功率100.00%,14例患者行EST术,4例行EPBD术,胆总管结石全部取净,取净率为100.00%;1例胆管癌行EMRE术,1例胆道术后胆管狭窄行ERBD术,发生1例高淀粉酶血症,未出现消化道穿孔、大出血等严重并发症.结论 毕罗Ⅱ式胃大部切除术后合并胆管疾病患者在接受内镜逆行性胰胆管造影术时,透明帽辅助胃镜有利于提供良好的术野,便于空肠袢内进镜,提高胆管插管成功率,利于结石清除,提高手术成功率,减少严重并发症,保障手术安全性,可在临床推广应用.Objective To explore the clinical application value of transparent cap gastroscope in the Billroth Ⅱ procedure after subtotal gastrectomy in patients with bile duct diseases by endoscopic retrograde cholangiopancreatography（ERCP）.Methods 20 patients underwent ERCP with Billroth Ⅱ gastrectomy postoperation with biliary diseases were selected as the research subjects,selected the transparent cap gastroscope ERCP,successful intubation received endoscopic sphincterotomy（EST） and（or） endoscopic nasobiliary drainage（ENBD）,endoscopic papillary balloon dilatation（EPBD）,endoscopic biliary metal stent drainage（EMBE）,endoscopic biliary drainage（ERBD） treatment.Results 20 patients with Billroth Ⅱ gastrectomy after angiography were successful,the successful rate was 100.00%,14 cases of EST patients,4 patients underwent EPBD surgery,common bile duct stones all took the net,took the net rate of 100.00%;1 case of bile duct cancer underwent EMRE resection,1 case of bile duct stenosis after biliary tract surgery ERBD operation,hyperamylasemia occurred in 1 case,no serious complications such as bleeding and perforation of digestive tract.Conclusion Billroth Ⅱ gastrectomy postoperative patients with bile duct disease receiving ERCP,endoscopic transparent cap can provide good operative field for jejunal loop inside the mirror,improve the success rate of bile duct intubation,conducive to the removal of stones,improve the success rate of surgery,reduce complications security,safety of operation,and can be used in clinical application.

关 键 词：胃镜检查 胰胆管造影术 内窥镜逆行 胃切除术 胆管疾病 

分 类 号：R657.4[医药卫生—外科学]