负压吸引法在内镜下经十二指肠乳头保胆取石术中的应用研究

Application of negative pressure suction to endoscopic transpapillary gallbladder‑preserving cholecystolithotomy

摘要:

为探究采用内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography， ERCP）联合单人经口胆道镜（SpyGlass）行经十二指肠乳头保胆取石术的有效性和安全性，并观察负压吸引法在取净胆囊结石及防止结石复发中可行性，回顾性分析2022年8月至2023年8月于北京友谊医院内镜中心采用负压吸引法行内镜下经十二指肠乳头保胆取石术的4例胆囊结石患者的临床资料，记录手术成功率和结石清除率、胆囊管超选时间、胆囊取石时间、术后并发症发生率等指标。手术成功率和结石清除率均为100%。胆囊管超选时间为6~30 min，其中2例患者在X线引导下进行胆囊管超选，超选时间分别为20 min和30 min；另2例患者为单人经口胆道镜引导下胆囊管超选，超选时间为6 min和8 min。胆囊取石时间为8~20 min，其中1例患者胆囊结石最大径为1 cm，激光碎石后使用取石网篮将结石取出；4例患者术中均使用网篮取石及负压吸引法取净结石。无严重并发症发生。术后随访8.5~24.0个月，无结石复发。本研究初步认为，内镜下经十二指肠乳头保胆取石术由于其超级微创的优势，技术上相对安全有效，值得临床进一步开展应用。

Abstract:

To investigate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) combined with single peroral choledochoscopy (SpyGlass) system for transpapillary gallbladder-preserving cholecystolithotomy, and to assess the feasibility of negative pressure suction for complete removal of gallbladder stones and prevention of recurrence, data of 4 patients with gallbladder stones, who received transpapillary gallbladder-preserving cholecystolithotomy through ERCP combined with SpyGlass with method of negative pressure suction at Endoscopy Center of Beijing Friendship Hospital from August 2022 to August 2023 were retrospectively reviewed. The procedure success rate, stone removal rate, the time of cystic duct cannulation, the time of stone removal and incidence of postoperative complication were recorded. The technique success rate of ERCP combined with SpyGlass was 100%, and the stone removal rate was also 100%. The time of cystic duct cannulation was 6-30 min, 2 patients were cannulated via X ray, and the time of cystic duct cannulation was 20 min and 30 min respectively; the other 2 patients were cannulated via SpyGlass, and the time of cystic duct cannulation was 6 min and 8 min respectively. The time of stone removal was 8-20 min, stones of 1 patient were crashed by laser lithotrisy followed by extraction basket due to diameter larger than 1 cm. Stones of all patients were completely removed by using extraction basket and the method of negative pressure suction. No severe adverse event occurred. There was no recurrence of gallbladder stone during the follow-up of 8.5-24.0 months. It is preliminarily believed that endoscopic transpapillary gallbladder-preserving cholecystolithotomy is safe and effective due to its super minimally invasive advantages, which is worth of further clinical application.