胆总管十二指肠瘘伴十二指肠球部溃疡狭窄经内镜逆行胰胆管造影会师术病例分析  

Case Analysis of Choledochoduodenal Fistula with Duodenal Bulbar Ulcer Stenosis by Endoscopic Retrograde Cholangiopanchography

作　　者：吴云芳 李平 Wu Yunfang;Li Ping(Department of Endoscopy Center,Xiamen Hospital of Zhongshan Hospital Affiliated to Fudan University,Xiamen 361006,Fujian Province,China)

机构地区：[1]复旦大学附属中山医院厦门医院内镜中心,福建厦门361006

出　　处：《中外医药研究》2024年第10期52-54,共3页JOURNAL OF CHINESE AND FOREIGN MEDICINE AND PHARMACY RESEARCH

基　　金：厦门市指导性课题(编号:3502Z20224ZD1069)。

摘　　要：总结1例胆总管十二指肠瘘(CDF)伴十二指肠球部溃疡狭窄患者经内镜逆行胰胆管造影(ERCP)会师术的手术配合过程,为十二指肠球部溃疡狭窄内瘘ERCP困难插管患者的手术治疗提供思路.GIF-Q260J胃镜前端安装透明帽从十二指肠瘘口逆向将导丝送入胆总管内,逆向抽离导丝,使导丝可从狭窄下段的十二指肠乳头穿过,留置导丝另一端于胆总管内,从而完成插管,进行胆道扩张,顺利放置支架引流.患者术后感染指标与直接胆红素指标均下降,顺利出院.选择GIF-Q260J胃镜行ERCP会师术,可勉强越过十二指肠球部狭窄段,利用瘘口逆向插管会师术为CDF伴十二指肠球部溃疡狭窄患者提供独特的治疗思路,医生与护士紧密配合,根据患者术中的情况随时评估调整手术方案,同时也需要医生有较高的技术水平以及准确地判断.To summarize the operation coordination process of endoscopic retrograde cholangiopanchography(ERCP)for a patient with choledochal duodenal fistula(CDF)complicated with duodenal bulbar ulcer stenosis,and to provide ideas for the surgical treatment of patients with ERCP difficult intubation for duodenal bulbar ulcer stenosis.A transparent cap was installed at the front end of GI-Q260J gastroscope to reverse the guide wire into the common bile duct from the duodenal fistula,and reverse the guide wire was pulled out so that the guide wire could pass through the duodenal papilla in the lower segment of the stenosis,and the other end of the guide wire was placed in the common bile duct to complete the intubation,perform biliary duct dilation,and smoothly place the stent drainage.The postoperative infection index and direct bilirubin index of the patient decreased,and the patient was discharged successfully.Choosing GIF-Q260J gastroscopy for ERCP rendezvous surgery can barely cross the narrow segment of the duodenal bulb,and using reverse intubation of the fistula to provide a unique treatment approach for CDF patients with duodenal bulb ulcer stenosis.Doctors and nurses work closely together to evaluate and adjust surgical plans based on the patient's condition during surgery,while also requiring doctors to have a high level of technical proficiency and accurate judgment.

关 键 词：经内镜逆行胰胆管造影会师术 十二指肠球部溃疡狭窄 胆总管十二指肠瘘 

分 类 号：R574.51[医药卫生—消化系统] R659[医药卫生—内科学]