内镜治疗Roux-en-Y术后并发急性梗阻性化脓性胆管炎的新方法——经腹壁小肠造瘘逆行进镜ERC

目的 探讨上消化道重建术后患者无法经口完成内镜逆行胆管造影术(ERC)时经腹壁入路小肠造瘘ERC的价值.方法 2例胆管癌根治术后再发急性梗阻性化脓性胆管炎患者,因无功能空肠襻迂曲、过长,无法完成经口ERC,先行腹壁切开找到输入襻小肠造瘘,自瘘口送入胃镜,沿无功能空肠襻逆行进镜找到胆肠吻合口,行ERC并胆管支架置入术(ERBD).结果 行腹壁切开并成功于无功能空肠襻小肠造瘘,经造瘘口沿空肠襻逆行进镜发现胆肠吻合口狭窄,肝内胆管可见大量脓性黏液,遂扩张吻合口行ERC,并于扩张的肝内胆管主要分支内置入支架,患者术后恢复顺利.结论 胆管癌根治、Roux-en-Y上消化道重建术后患者罹患胆管疾病无法经口完成ERC时,经腹壁入路小肠造瘘逆行进镜行诊断及治疗性ERC是安全、有效的方法.

A new endoscopic therapeutic method for acute obstructive suppurative cholangitis post Rouxen-Y anastomosis: endoscopic retrograde cholangiography through jejunostomy

Objective The present study was to probe the value of endoscopic retrograde cholangiography(ERC) through jejunostomy in patients in whom ERC could not ba performed via the mouth after Roux-en-Y anastomosis on the upper gastrointestinal tract.Methods In two patients were suffering from acute obstructive suppurative cholangitis after a radical operation for cholangiocarcinoma,ERC could not done through the mouth due to the presence of a long non-functional intestinal loop.A jejunostomy was first done in the afferent loop of the jejunam.A gastroscope was then inserted via the jejunostomy,and it was passed retrogradely,to find the stoma of the cholangio-intestinal anastomosis.ERC was then successfully performed,and it was followed by endoscopic retrograde biliary drainage(ERBD).Results The operation was suecessful.It was found that cholangio-jejunostomy stoma was narrow,and a large amount of purulent mucus was present in the enlarged intrahepatic duct.ERC was done to enlarge the stoma,and a stent was placed into the main branch of the intrahepatic duct.The operation was successfully done in two patients,and they recovered smoothly after the operation.Conclusion ERC through a jejunostomy in patients who had had Roux-en-Y cholangio-jejunostomy following radical resection for cholangiocarcinoma,is a safe and effective surgical procedure.