超声内镜引导下胆道引流术对胃肠道重建患者术后胆道梗阻的临床疗效（含视频）

Clinical efficacy of endoscopic ultrasound-guided biliary drainage for biliary obstruction after gastrointestinal reconstruction

摘要:

为评估超声内镜引导下胆道引流术（endoscopic ultrasound-guided biliary drainage，EUS-BD）对胃肠道术后解剖结构改变患者胆道梗阻的临床疗效，回顾性分析2023年3月至2025年6月期间消化道重建术后解剖结构发生改变伴发胆道梗阻而接受EUS-BD的34例患者资料，评估EUS-BD的技术成功率、临床成功率和EUS-BD相关不良事件发生率。结果显示，34患者共行39次EUS-BD，技术成功率为97.4%（38/39），临床成功率为87.9%（29/33），EUS-BD相关不良事件发生率为14.7%（5/34），其中感染3例，出血1例，术后胆管炎1例，均经保守治疗后好转，无EUS-BD相关死亡病例。患者术后1个月丙氨酸氨基转移酶、天冬氨酸氨基转移酶、碱性磷酸酶、γ-谷氨酰转移酶和血清总胆红素较术前均明显下降（P＜0.05），直接胆红素、白细胞计数和C反应蛋白变化水平无统计学意义（P＞0.05）。本研究认为EUS-BD是治疗胃肠道术后解剖结构改变患者胆道梗阻的一种有效的方法，但术后仍需重点关注相关不良事件。

Abstract:

To evaluate the clinical efficacy of endoscopic ultrasound-guided biliary drainage (EUS-BD) for biliary obstruction in patients with anatomical changes after gastrointestinal surgery,the data of 34 patients who underwent EUS-BD due to anatomical changes after digestive tract reconstruction from March 2023 to June 2025 were retrospectively analyzed. The technical success rate, clinical success rate and incidence of EUS-BD-related adverse events were evaluated.A total of 39 times of EUS-BD were performed in 34 patients. The technical success rate was 97.4% (38/39), the clinical success rate was 87.9% (29/33), and the incidence of EUS-BD-related adverse events was 14.7% (5/34). There were 3 cases of infection, 1 case of bleeding, and 1 case of postoperative cholangitis. All of them were improved after conservative treatment, and there was no EUS-BD-related death. Alanine aminotransferase,aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transferase and serum total bilirubin decreased significantly at 1 month after operation (P<0.05).This study suggests that EUS-BD is an effective method for the treatment of biliary obstruction in patients with anatomical changes after gastrointestinal surgery, but postoperative adverse events still need to be focused on.