Endoscopic ultrasound-guided choledochoduodenostomy in patients with failed endoscopic retrograde cholangiopancreatography
Endoscopic ultrasound-guided choledochoduodenostomy in patients with failed endoscopic retrograde cholangiopancreatography
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DOI：
10.3748/wjg.14.6078
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发表时间：
2008-10-21
影响因子：
4.3
通讯作者：
Moriyasu, Fuminori
中科院分区：
文献类型：
--
作者：
Itoi, Takao;Itokawa, Fumihide;Moriyasu, Fuminori
内镜超声检查 (EUS) 引导下的胆道引流术用于治疗内镜逆行胰胆管造影 (ERCP) 失败而出现梗阻性黄疸的患者。在本研究中，我们介绍了 EUS 引导下胆总管十二指肠吻合术对 4 名 ERCP 失败患者的可行性和结果。我们对2例Vater乳头进行了手术，其中1例可切除病例，2例胰头癌病例。使用弯曲线性阵列回声内窥镜，在 EUS 可视化下将 19 G 针或针刀经十二指肠刺入胆管。使用胆管扩张器或乳头状球囊扩张器，将 7-Fr 塑料支架通过胆总管十二指肠吻合部位插入肝外胆管。 4例中有3例（75%）放置了留置塑料支架，1例因支架无法进入胆管而放置了鼻胆引流管。在所有病例中，梗阻性黄疸在手术后均迅速改善。 1例出现局灶性腹膜炎和出血，无需输血。在该病例中，进行了胰十二指肠切除术，手术结果显示胆总管十二指肠吻合部位周围存在严重粘连。尽管必须进一步研究和开发设备，但在某些情况下，EUS 引导的胆总管十二指肠吻合术似乎是 ERCP 的有效替代方案。 (c) 2008 年 WJG 出版社。版权所有。
Endoscopic ultrasonography (EUS)-guided biliary drainage was performed for treatment of patients who have obstructive jaundice in cases of failed endoscopic retrograde cholangiopancreatography (ERCP). In the present study, we introduced the feasibility and outcome of EUS-guided choledochoduodenostomy in four patients who failed in ERCP. We performed the procedure in 2 papilla of Vater, including one resectable case, and 2 cases of cancer of the head of pancreas. Using a curved linear array echoendoscope, a 19 G needle or a needle knife was punctured transduodenally into the bile duct under EUS visualization. Using a biliary catheter for dilation, or papillary balloon dilator, a 7-Fr plastic stent was inserted through the choledochoduodenostomy site into the extrahepatic bile duct. In 3 (75%) of 4 cases, an indwelling plastic stent was placed, and in one case in which the stent could not be advanced into the bile duct, a naso-biliary drainage tube was placed instead. In all cases, the obstructive jaundice rapidly improved after the procedure. Focal peritonitis and bleeding not requiring blood transfusion was seen in one case. In this case, pancreatoduodenectomy was performed and the surgical findings revealed severe adhesion around the choledochoduodenostomy site. Although further studies and development of devices are mandatory, EUS-guided choledochoduodenostomy appears to be an effective alternative to ERCP in selected cases. (c) 2008 The WJG Press. All rights reserved.