ERCP联合SpyGlass系统治疗高危胆囊结石合并继发胆总管结石可行性研究  

ERCP combined with SpyGlass system for the treatment of concomitant gallbladder stones and secondary common bile duct stones in high-risky surgical patients

作　　者：张航 刘丹青 肖乐 张炳印 刘卫辉 ZHANG Hang;LIU Dan-qing;XIAO Le(Department of Clinical Medical College,Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学临床医学院,四川泸州646000 [2]中国人民解放军成都军区总医院全军普通外科中心,四川成都610083

出　　处：《中国实用外科杂志》2018年第11期1310-1313,共4页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金(No.81302168)

摘　　要：目的探讨内镜逆行胰胆管造影(ERCP)联合SpyGlass系统治疗高危胆囊结石合并继发胆总管结石的可行性。方法回顾性分析2016年12月至2017年3月中国人民解放军成都军区总医院全军普外中心采用ERCP联合SpyGlass系统处置的4例高危胆囊结石合并继发胆总管结石病人的临床资料。结果 4例病人均手术成功,结石彻底清除;ERCP操作时间38~62 min,SpyGlass检查时间为17~33 min;术后不良事件较轻,1例病人出现急性胆囊炎,1例出现无症状高淀粉酶血症,Clavien-Dindo并发症分级均为Ⅱ级,经保守治疗后痊愈;术后恢复流质饮食时间90~102 h,术后住院时间5~6 d;术后3个月复查彩超胆囊及胆总管均未见结石复发;同时行胆囊功能测定,结果显示胆囊收缩功能良好。结论针对高危外科手术的胆囊结石合并继发胆总管结石病人,采用ERCP联合SpyGlass系统的策略安全可行,值得进一步探索和研究。Objective To assess the clinical feasibility of endoscopic retrograde cholangiopancreatography（ERCP） combined with SpyGlass system for the treatment of concomitant gallbladder stones and secondary common bile duct stones in high-risky surgical patients. Methods A retrospective review of 4 consecutive patients with concomitant gallbladder stones and secondary common bile duct stones, who accepted ERCP combined with SpyGlass system to treat in General Surgery Center of PLA, Chengdu Military General Hospital from December 2016 to March 2017 were performed. Results The technique success rate of ERCP combined with SpyGlass system was 100%, and the stone removal rate also was 100%; ERCP operating time was 38-62 min, SpyGlass examination time was 17-33 min; All adverse events were mild, one patient developed acute cholecystitis and one patient underwent hyperamylasemia after surgery and both were cured by conservative treatment. According to Clavien-Dindo classification, all post-operative complications were grade ]I. Abdominal ultrasound suggested that no stone residual in gallbladder and common bile duct within 3 months after the operation. In addition the gallbladder contractility function was normal in 3 months after the operation. Conclusion ERCP combined with SpyGlass system for the treatment of concomitant gallbladder stones and secondary common bile duct stones is safe and feasible in high-risky surgical patients.

关 键 词：内镜逆行胰胆管造影 SpyGlass系统 胆囊结石 胆总管结石 金属覆膜支架 

分 类 号：R6[医药卫生—外科学]