【摘要】 目的介绍和探讨应用前视镜对胃大部切除毕Ⅱ式吻合术后胆道疾病患者的内镜下治疗的价值。方法对2007年1月～2010年12月两院消化内镜中心经内镜下逆行胰胆管造影术(ERCP)治疗的26例胃大部切除毕Ⅱ式吻合术后合并胆道疾病患者的病例进行回顾性分析,以评价前视镜对胃大部切除毕Ⅱ式吻合术后胆道疾病患者的内镜下治疗的价值。结果 26例胃大部切除毕Ⅱ式吻合术后合并胆道疾病患者中行治疗性ERCP成功21(80.8%)例,失败5(19.2%)例。在21例成功插管中,使用柱状球囊扩张法10例,胆道支架加针形刀切开十二指肠乳头5例,小切开加大气囊扩张法4例,未进行括约肌处理2例。内引流4例,鼻胆管外引流4例,成功取石13例。术后轻中度发热2例,高淀粉酶血症2例,胰腺炎1例,无出血和穿孔发生。结论前视镜是治疗胃大部切除毕Ⅱ式吻合术后胆道疾病患者的安全有效手段,可以提高成功率和避免穿孔严重并发症发生,但操作具有难度,可在有技术条件的医院选择性开展。更多还原

【Abstract】 [Objective] To introduce and discuss the treatment of patients with biliary tract diseases after gastrectomy and Billroth Ⅱ gastrojejunostomy under electronic forward-viewing endoscope.[Methods] Out of the patients who underwent ERCP between January 2007 and December 2010 in our hospital,26 had biliary tract diseases and a previous Billroth Ⅱ gastrectomy.The records of these 26 patients were reviewed.Details notes include therapeutic interventions,causes of failure and complications.[Results] Billroth Ⅱ gastrojejunostomy ERCP was successfully performed in 21 out of the 26 patients.Of the 21 patients who had successful ERCP,papillary balloon dilation was performed in 10 patients,needle-knife precut paillotomy after placement of a pancreatic duct stent in 4 patients,large papillary balloon dilation afer small precut paillotomy in 4 patients,and 3 patients didn’t accepted any treatment for the biliary sphincter.Bile duct stent was performed in 4 patients.4 patients received a nasobiliary catheter.One patient had complication of transient acute pancreatitis and relieved soon after medical treatment.All the patients had no complications of perforation and hemorrhage caused by endosopic management.[Conclusions] Diagnostic and therapeutic ERCP with a regular forward-viewing endoscope was successful in all patients with biliary tract diseases and a prior Billroth Ⅱ gastrectomy.The high rate of successful ERCP was achieved by improving afferent loop intubation with a forward-viewing endoscope,but it is difficult,so it should be selectively applied in some hospitals.更多还原