毕Ⅱ式胃切除术后内镜下逆行胰胆管造影术的回顾分析

Retrospective analysis of endoscopic retrograde cholangiopancreatography in patients with prior Billroth Ⅱ gastrectomy

摘要:

目的 评价毕Ⅱ式胃切除术后内镜下逆行胰胆管造影术（ERCP）治疗胆胰疾病的有效性和安全性，并初步总结经验。 方法 回顾性分析2011年1月至2016年12月长海医院消化内镜中心237次ERCP治疗的178例毕Ⅱ式胃切除术后胆胰疾病患者的临床资料，总结ERCP操作成功率及相关并发症发生情况。 结果 内镜到达十二指肠乳头的进镜成功率为83.5%（198/237），选择性胆胰管插管成功率为91.4%（181/198），完成预期操作的治疗成功率为98.9%（179/181）。毕Ⅱ式ERCP的总成功率为75.5%（179/237），各年总成功率呈上升趋势。其中胆总管结石ERCP总成功率为85.2%（127/149），结石一次取净率为56.7%（72/127）。毕Ⅱ式ERCP相关并发症发生率为14.3%（34/237），其中穿孔1.7%（4/237）、出血1.3%（3/237）、胰腺炎3.4%（8/237）、无症状性高淀粉酶血症8.0%（19/237）。1例穿孔和2例重症胰腺炎患者，因继发感染性休克、多器官功能衰竭而死亡（1.3%，3/237）。大部分ERCP相关并发症经药物保守治疗或内镜再次干预得以好转（91.2%，31/34）。 结论 毕Ⅱ式胃切除术后ERCP总体上是有效和安全的，随着内镜技术的发展和术者经验的成熟，进镜、选择性胆胰管插管和治疗性干预的成功率均可接近正常解剖结构患者，相关并发症发生率较低。

Abstract:

Objective To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of biliary and pancreatic diseases after Billroth II gastrectomy, and to summarize the preliminary experience. Methods The clinical data of 178 patients with biliary and pancreatic diseases who underwent 237 ERCP sessions at the digestive endoscopy center in Changhai Hospital from January 2011 to December 2016 were retrospectively analyzed. The success rate of ERCP procedures and related complications were summed up. Results The successful intubation of the endoscope to reach the duodenal papilla was 83.5% (198/237), selective cannulation was 91.4% (181/198), and the success rate of completing the expected intervention was 98.9% (179/181). The total success rate of ERCP was 75.5% (179/237), which had an increasing trend in each year. Among them, the total success rate of ERCP in patients with common bile duct stones was 85.2% (127/149), and the stone retrieval rate during the first session was 56.7% (72/127). The ERCP-related complication rate was 14.3% (34/237), with perforation was 1.7% (4/237), bleeding 1.3% (3/237), pancreatitis 3.4% (8/237), asymptomatic hyperamylasemia 8.0% (19/237). One patient with perforation and two patients with severe pancreatitis died of septic shock and multiple organ failure (1.3%, 3/237). Most ERCP-related complications improved by conservative treatment or endoscopic intervention again (91.2%,31/34). Conclusion ERCP is effective and safe in the treatment of biliary and pancreatic diseases in patients with prior Billroth Ⅱ gastrectomy. With the development of endoscopic techniques and the experience of endoscopists, the success rate of intubation, selective cannulation and therapeutic intervention can be close to normal anatomical patients, and the incidence of related complications is low.