内镜超声引导下胆管引流术治疗恶性梗阻性黄疸的价值（含视频）  

Value of endoscopic ultrasonography-guided biliary drainage for malignant obstructive jaundice（ with video）

作　　者：陈萃[1] 叶志霞 孙波[1] 王田田[1] 王淑萍[1] 王书智[1] 胡冰[1] Chen Cui;Ye Zhixia;Sun Bo;Wang Tiantian;Wang Shuping;Wang Shuzhi;Hu Bing(Department of Endoscopy,Eastern Hepatobiliary Surgery Hospital,Shanghai 200438,Chin)

机构地区：[1]东方肝胆外科医院内镜科,上海200438 [2]东方肝胆外科医院护理部,上海200438

出　　处：《中华消化内镜杂志》2018年第8期557-561,共5页Chinese Journal of Digestive Endoscopy

基　　金：上海市2016年度“科技创新行动计划”医学领域项目（16411951700）

摘　　要：目的探讨内镜超声引导下胆管引流术（EUS—BD）治疗恶性梗阻性黄疸的疗效及并发症处理。方法回顾性分析2016年4月至2017年1月共12例因恶性梗阻性黄疸行EUS—BD的患者临床及内镜操作资料。患者均因ERCP胆管引流失败或无法完成而改行EUS—BD，包括EUS引导下经胃经肝内胆管穿刺造瘘术（EUS-HGS）、胆管穿刺顺行金属支架置入术（EUS—AS）及经十二指肠经肝外胆管穿刺造瘘术（EUS—CDS）。记录操作完成情况、术前及术后1周内血清胆红素及肝酶水平、并发症发生及处理结果、住院天数及随访等。结果本组患者中2例行EUS—HGS，3例行EUS—AS，7例行EUS—CDS。术后总胆红素（t=3．462，P=0．005），直接胆红素（t=3．351，P=0．006），丙氨酸转氨酶（t=2．399，P=0．037），γ-谷氨酸转肽酶（t=3．256，P=0．031）均较术前显著下降，黄疸症状明显改善。术后发生并发症2例（16．67％）。1例EUS—HGS患者发生胆漏、胆汁性腹膜炎及气腹；1例EUS—CDS患者发生上消化道出血，均成功治疗。无急性胰腺炎、皮下气肿、气胸、纵隔气肿等并发症发生，无死亡病例。住院天数5—26d，平均（13．75±6．92）d。结论在具有丰富ERCP与EUS操作经验的内镜中心，EUS-BD可作为ERCP胆管支架置入失败后的替代方法，术后需重点监护，及时发现与处理并发症。Objective To analyze the efficacy of endoscopic ultrasonography-guided biliary drainage （EUS-BD） for malignant obstructive jaundice and the management of adverse events. Methods Clinical data of 12 patients with malignant obstructive jaundice, who underwent EUS-BD between April 2016 and January 2017, were retrospectively analyzed. All patients received EUS-BD after unsuccessful ERCP, including EUS-guided hepaticogastrostomy （ EUS-HGS）, EUS-guided antegrade stenting （ EUS-AS）, and EUS-guided choledochoduodenostomy （EUS-CDS）. Procedure outcomes, serum bilirubin and liver enzyme levels before the procedure and 1 week after, complications, treatment results, hospitalization time and follow-up were recorded. Results Two patients underwent EUS-HGS, 3 underwent EUS-AS, and 7 underwent EUS-CDS. Total bilirubin （ t = 3.462, P = 0. 005 ）, direct bilirubin （ t = 3. 351, P = 0. 006 ）, alanine transaminase （ t = 2. 399, P = 0. 037 ）, 7-glutamate transpeptidase （ t = 3. 256, P = 0. 031 ） reduced significantly after the procedure. Two patients （16. 67%） developed complications. A patient undergoing EUS-HGS developed bile leakage, biliary peritonitis, and pneumoperitoneum. A patient undergoing EUSCDS developed upper gastrointestinal bleeding. Both patients were successfully treated. There were no other adverse events, such as acute pancreatitis, subcutaneous emphysema, pneumothorax and emphysema. No procedure-related death occurred. The mean hospital stay was 13.75 ± 6.92 days （range 5-26 days）. Conclusion EUS-BD is a safe substitute after unsuccessful ERCP when performed by experienced biliary endoscopists. However, intensive care is necessary after the procedure for early detection and management of complications.

关 键 词：腔内超声检查 胆管引流术 肝内胆管胃造瘘术 胆总管十二指肠造瘘术并发症 

分 类 号：R657.43[医药卫生—外科学]