经口胆道镜联合经皮胆道穿刺引流会师术治疗Beger术后胆瘘1例报告

王语馨; 顾伟刚; 金正; 张筱凤

doi:10.12449/JCH250220

经口胆道镜联合经皮胆道穿刺引流会师术治疗Beger术后胆瘘1例报告

DOI: 10.12449/JCH250220

王语馨^{1, 2},
顾伟刚²,
金正²,
张筱凤^{1, 2, 3, 4, , ,}

1.
浙江中医药大学第四临床医学院，杭州 310003
2.
西湖大学附属杭州市第一人民医院消化内科，杭州 310058
3.
浙江省中西医结合胆胰疾病重点实验室，杭州 310006
4.
浙江省临床肿瘤药理与毒理学研究重点实验室，杭州 310058

基金项目:

杭州市重点医学学科建设基金 (OO20190001)

伦理学声明：本例报告已获得患者知情同意。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：王语馨负责资料分析，撰写论文；顾伟刚参与收集数据，修改论文；金正参与论文修改；张筱凤指导撰写文章，修改并最后定稿。

详细信息

通信作者:
张筱凤， 19883201892@163.com （ORCID： 0009-0007-1858-8905）

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出版历程
- 收稿日期: 2024-07-23
- 录用日期: 2024-08-26
- 出版日期: 2025-02-25

Successful treatment of biliary fistula after Beger surgery by oral choledochoscopy-assisted percutaneous-endoscopic rendezvous technique： A case report

Yuxin WANG^{1, 2},
Weigang GU²,
Zheng JIN²,
Xiaofeng ZHANG^{1, 2, 3, 4
, ,
,}

1.
The Fourth Clinical Medical College of Zhejiang Chinese Medical University，Hangzhou 310003，China
2.
Department of Gastroenterology，Affiliated Hangzhou First People’s Hospital，Westlake University School of Medicine，Hangzhou 310058，China
3.
Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province，Hangzhou 310006，China
4.
Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province，Hangzhou 310058，China

Research funding:

The Construction Fund of Key Medical Disciplines of Hangzhou (OO20190001)

More Information

Corresponding author: ZHANG Xiaofeng， 19883201892@163.com （ORCID： 0009-0007-1858-8905）

摘要

摘要: 保留十二指肠胰头局部切除术（Beger术）术后胆管损伤发生率较高，而胆管损伤的治疗方式取决于损伤严重程度，内镜治疗在胆管损伤严重的情况下较困难。近期西湖大学附属杭州市第一人民医院收治1例因Beger术后出现胆瘘的患者，通过经口胆道镜联合经皮胆道穿刺引流会师术成功诊治，取得良好效果。
- 胆瘘 /
- 穿刺抽液术 /
- 胰胆管造影术，内窥镜逆行
Abstract: Duodenum-preserving pancreatic head resection， also known as Beger surgery， has a high incidence rate of bile duct injury after surgery， while the treatment modality for bile duct injury depends on the severity of the injury， and endoscopic therapy is often challenging in case of severe bile duct injury. Recently a patient with biliary fistula after Beger surgery was admitted to Affiliated Hangzhou First People’s Hospital， Westlake University， and successful diagnosis and treatment were achieved through oral choledochoscopy-assisted percutaneous-endoscopic rendezvous technique.
- Biliary Fistula /
- Paracentesis /
- Cholangiopancreatography， Endoscopic Retrograde

HTML全文

注： a，胰头术后改变，术区引流管旁小条片高密度影；b，肝内胆管纤细。

图 1 腹部CT平扫

Figure 1. Abdominal computed tomography

下载: 全尺寸图片幻灯片

注： a，造影剂在后腹腔局部聚集；b，胆总管中上段显影，下端轻度狭窄；置入导丝，导丝无法越过胆瘘处，反复进入胆汁湖；c，置入子镜，直视下见胆瘘处下端管壁。

图 2 第一次行ERCR

Figure 2. Endoscopic retrograde cholangiopancreatography for the first time

下载: 全尺寸图片幻灯片

注：腹部CT平扫示肝内胆管扩张。

图 3 腹部CT平扫

Figure 3. Abdominal computed tomography

下载: 全尺寸图片幻灯片

注：导管导丝配合下通过肝总管段进入胆总管内，造影显示胆总管下端见造影剂团片状外漏，未见十二指肠显影，将8Fr引流管头端置于胆汁湖内。

图 4 经皮经肝左侧肝内胆管置管引流术

Figure 4. Percutaneous transhepatic cholangiography

下载: 全尺寸图片幻灯片

注： a，子镜见腹引管管壁及PTCD管头端；b，沿PTCD管置入斑马导丝至胆汁湖内；c，用网篮在X线下套取经PTCD顺行导丝从乳头拉出；d，逆行置入全覆膜金属支架（10 mm×6 cm）越过胆瘘上端1.5 cm，将PTCD管前端调整至肝门处。

图 5 经皮内镜会师术

Figure 5. Percutaneous-endoscopic rendezvous technique

下载: 全尺寸图片幻灯片

注：经皮胆管引流术后，胆道金属支架置入术后，支架位置良好。

图 6 腹部CT

Figure 6. Abdominal computed tomography

下载: 全尺寸图片幻灯片

参考文献(13)

[1]	BUSQUETS J, FABREGAT J, BOROBIA FG, et al. Organ-preserving surgery for benign lesions and low-grade malignancies of the pancreatic head: A matched case-control study[J]. Surg Today, 2010, 40( 2): 125- 131. DOI: 10.1007/s00595-008-4038-6.
[2]	BEGER HG, SIECH M, POCH B, et al. Limited surgery for benign tumours of the pancreas: A systematic review[J]. World J Surg, 2015, 39( 6): 1557- 1566. DOI: 10.1007/s00268-015-2976-x.
[3]	BEGER HG, MAYER B, RAU BM. Parenchyma-sparing, limited pancreatic head resection for benign tumors and low-risk periampullary cancer: A systematic review[J]. J Gastrointest Surg, 2016, 20( 1): 206- 217. DOI: 10.1007/s11605-015-2981-2.
[4]	BEGER HG, NAKAO A, MAYER B, et al. Duodenum-preserving total and partial pancreatic head resection for benign tumors: Systematic review and meta-analysis[J]. Pancreatology, 2015, 15( 2): 167- 178. DOI: 10.1016/j.pan.2015.01.009.
[5]	BEGER HG, MAYER B, RAU BM. Parenchyma-sparing, limited pancreatic head resection for benign tumors and low-risk periampullary cancer—a systematic review[J]. J Gastrointest Surg, 2016, 20( 1): 206- 217. DOI: 10.1007/s11605-015-2981-2.
[6]	GU W, WANG Y, SHEN H, et al. Value of endoscopic biliary and pancreatic duct stents in local resection of intraductal papillary myxoma of pancreatic head[J]. J Hepatobiliary Surg, 2023, 31( 4): 296- 299. DOI: 10.3969/j.issn.1006-4761.2023.04016.
[7]	LU C, XU BW, MOU YP, et al. Laparoscopic duodenum-preserving pancreatic head resection with real-time indocyanine green guidance of different dosage and timing: Enhanced safety with visualized biliary duct and its long-term metabolic morbidity[J]. Langenbecks Arch Surg, 2022, 407( 7): 2823- 2832. DOI: 10.1007/s00423-022-02570-0.
[8]	de REUVER PR, GROSSMANN I, BUSCH OR, et al. Referral pattern and timing of repair are risk factors for complications after reconstructive surgery for bile duct injury[J]. Ann Surg, 2007, 245( 5): 763- 770. DOI: 10.1097/01.sla.0000252442.91839.44.
[9]	BEKTAS H, SCHREM H, WINNY M, et al. Surgical treatment and outcome of iatrogenic bile duct lesions after cholecystectomy and the impact of different clinical classification systems[J]. Br J Surg, 2007, 94( 9): 1119- 1127. DOI: 10.1002/bjs.5752.
[10]	RAZA A, OMER A, IQBAL S, et al. Efficacy of nasobiliary tubes and biliary stents in management of patients with bile leak after liver transplantation: A systematic review[J]. Clin Endosc, 2019, 52( 2): 159- 167. DOI: 10.5946/ce.2018.118.
[11]	WEBER A, FEUSSNER H, WINKELMANN F, et al. Long-term outcome of endoscopic therapy in patients with bile duct injury after cholecystectomy[J]. J Gastroenterol Hepatol, 2009, 24( 5): 762- 769. DOI: 10.1111/j.1440-1746.2008.05713.x.
[12]	LEE Y, PARK CH, CHO E, et al. Management of post-liver transplantation biliary stricture inaccessible by endoscopic retrograde cholangiopancreatography: A case report[J]. World J Clin Cases, 2023, 11( 34): 8235- 8241. DOI: 10.12998/wjcc.v11.i34.8235.
[13]	ISHIDA T, HAYASHI E, TOJIMA Y, et al. Rupture of the common bile duct due to blunt trauma, presenting difficulty in diagnosis[J]. BMJ Case Rep, 2018, 11( 1): e226467. DOI: 10.1136/bcr-2018-226467.