内镜超声引导下胆管引流在胆管造影失败的梗阻性黄疸患者中的治疗价值（含视频）

Efficacy and safety of endoscopic ultrasound-guided biliary drainage on obstructive jaundice patients who had failed in the endoscopic retrograde cholangiography （with video）

摘要:

目的 探讨内镜超声引导下胆管引流术（EUS-BD）在经内镜逆行胆管造影术（ERC）失败的梗阻性黄疸患者中的有效性及安全性。 方法 回顾性分析2015年10月至2017年7月在南京鼓楼医院行EUS-BD的17例梗阻性黄疸患者资料，分析术式、技术成功率、临床有效性及术后并发症、随访情况。 结果 17例患者中16例手术成功，技术成功率94.1％（16／17）。采取的手术方式包括：内镜超声引导下肝胃吻合术12例；内镜超声引导下顺行金属支架置入术2例；内镜超声引导下会师术1例；内镜超声引导下胆总管十二指肠吻合术1例。手术成功的16例患者术后胆红素均有不同程度下降，临床有效率94.1％（16／17）。术后并发症包括胆道感染5例，胆漏2例，气腹、十二指肠穿孔1例。16例患者术后随访14～390 d，有2例患者术后1个月因原发病加重死亡，另有2例患者术后再发黄疸加重，循原途径更换支架后，胆红素再次下降。 结论 EUS-BD手术成功率及临床有效率均较高，可作为ERC失败的梗阻性黄疸患者的备选治疗方案，手术方式需根据患者的具体情况选择。

Abstract:

Objective To investigate the efficacy and safety of endoscopic ultrasound-guided biliary drainage （EUS-BD） on obstructive jaundice patients who had failed in the endoscopic retrograde cholangiography （ERC）. Methods Seventeen obstructive jaundice patients who underwent EUS-BD at Nanjing Drum Tower Hospital from October 2015 to July 2017 were enrolled in the study. The types of biliary drainage， technical success rate， clinical efficacy， post-procedure adverse events， and follow-up were analyzed. Results EUS-BD was successfully performed in 16 out of 17 patients， with technical success rate of 94.1％. Operation pathway included 12 EUS-guided hepaticogastrostomy， 2 EUS-guided antegrade stenting， 1 EUS-guided rendezvous， and 1 EUS-guided choledochoduodenostomy. All the 16 patients′ bilirubin decreased at different levels after operation， and the clinical success rate was 94.1％ （16／17）. Post-operation complications included 5 cases of cholangitis， 2 of bile leakage， and 1 of pneumoperitoneum and duodenal perforation. The patients were followed up for 14-390 days after procedures. Two patients died of underlying disease one month after operation. Jaundice in another 2 patients worsened during follow-up and were improved after replacement of previous stent. Conclusion EUS-BD has a relatively high technical success rate， and can be considered as an alternative choice for patients with obstructive jaundice after failure of ERC. Operation pathway should be decided according to patient′s condition.