内镜逆行胰胆管造影术中使用SpyGlass系统联合液电碎石治疗胆总管困难结石的效果及安全性分析

刘益均; 吴乔

doi:10.3969/j.issn.1001-5256.2021.07.032

内镜逆行胰胆管造影术中使用SpyGlass系统联合液电碎石治疗胆总管困难结石的效果及安全性分析

DOI: 10.3969/j.issn.1001-5256.2021.07.032

刘益均¹,
吴乔^2, ,

1.
重庆市荣昌区人民医院肝胆外科，重庆 402460
2.
重庆医科大学第一附属医院肝胆外科，重庆 400042

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：刘益均负责课题设计，资料分析，撰写论文，收集数据；吴乔负责拟定写作思路，修改论文，指导撰写文章并最后定稿。

详细信息

通信作者:
吴乔，784944194@qq.com

中图分类号: R657.42
计量
- 文章访问数: 990
- HTML全文浏览量: 388
- PDF下载量: 43
- 被引次数: 0
出版历程
- 收稿日期: 2020-12-30
- 录用日期: 2021-04-15
- 出版日期: 2021-07-20

Efficacy and safety of SpyGlass system combined with electrohydraulic lithotripsy during endoscopic retrograde cholangiopancreatography in treatment of difficult common bile duct stones

Yijun LIU¹,
Qiao WU^{2
, ,}

1.
Department of Hepatobiliary Surgery, People's Hospital of Rongchang County, Chongqing 402460, China
2.
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China

摘要

摘要: 目的评估内镜逆行胰胆管造影(ERCP)术中使用SpyGlass系统联合液电碎石治疗胆总管困难结石的有效性及安全性。方法选取2019年12月—2020年5月于重庆医科大学附属第一医院肝胆外科行经内镜逆行胰胆管造影术中使用SpyGlass系统联合液电碎石治疗胆总管困难结石的20例患者，检测术后肝功能、血淀粉酶、血脂肪酶水平；观察患者体温、腹痛以及合并胆道出血、感染、穿孔情况；术后复查是否存在胆总管残余结石。结果 20例患者中，18例一次性取石成功，无严重手术并发症；2例患者因术后复查见少许残余结石影，再次行ERCP下网篮取石及球囊胆道清理，二次取尽结石。未见胆道穿孔、大出血发生；术后诱发胰腺炎均为轻度，给予药物治疗后好转；部分患者血淀粉酶及脂肪酶水平升高，但无临床症状；术后肝功能均明显好转。所有患者取石术后3个月复查腹部彩超均未见胆总管残余结石。结论 ERCP术中使用SpyGlass系统联合液电碎石治疗胆总管困难结石一次性取净结石的成功率较高，且无明显手术并发症。
- 胆总管结石病 /
- 胰胆管造影术，内窥镜逆行 /
- SpyGlass /
- 碎石术
Abstract: Objective To investigate the efficacy and safety of SpyGlass system combined with electrohydraulic lithotripsy during endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of difficult common bile duct stones. Methods A total of 20 patients who used the SpyGlass system combined with electrohydraulic lithotripsy during ERCP for the treatment of difficult common bile duct stones in Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, from December 2019 to May 2020 were enrolled. Liver function, blood amylase, and blood lipase were measured after surgery; the patients were observed in terms of body temperature, abdominal pain, hematobilia, infection, and perforation; the presence or absence of residual common bile duct stones was reexamined after surgery. Results Of all 20 patients, 18 underwent successful lithotripsy on the first attempt without serious complications, and 2 underwent ERCP-guided basket extraction and biliary tract cleaning with balloon due to residual stones found in the reexamination after surgery and achieved complete removal of stones. No biliary tract perforation or massive hemorrhage was observed; there was mild pancreatitis after surgery, which was improved after pharmacotherapy; some patients had increased levels of blood amylase and lipase, without any clinical symptom; there was a significant improvement in liver function after surgery. Abdominal color Doppler ultrasound performed for all patients at 3 months after cholecystolithotomy showed no residual common bile duct stones. Conclusion SpyGlass system combined with electrohydraulic lithotripsy during ERCP has a high first-attempt success rate of complete removal of stones in the treatment of difficult common bile duct stones, without marked surgical complications.
- Choledocholithiasis /
- Cholangiopancreatography, Endoscopic Retrograde /
- SpyGlass /
- Lithotripsy

HTML全文

图 1 困难结石的CT图像直径测量

下载: 全尺寸图片幻灯片

图 2 困难结石的ERCP造影直径测量

下载: 全尺寸图片幻灯片

图 3 碎石电极接触结石表面

下载: 全尺寸图片幻灯片

图 4 液电击碎结石

下载: 全尺寸图片幻灯片

参考文献(14)

[1]	BOKEMEYER A, GERGES C, LANG D, et al. Digital single-operator video cholangioscopy in treating refractory biliary stones: A multicenter observational study[J]. Surg Endosc, 2020, 34(5): 1914-1922. DOI: 10.1007/s00464-019-06962-0.
[2]	LIN M, FAN ZN, HUANG J. Application progress of peroral choledochoscopy[J]. Chin J Min Inv Surg, 2018, 24(4): 338-340. DOI: 10.3969/j.issn.1009-6604.2018.04.013. 林敏, 范志宁, 黄锦. 经口胆道镜的应用进展[J]. 中国微创外科杂志, 2018, 24(4): 338-340. DOI: 10.3969/j.issn.1009-6604.2018.04.013.
[3]	KURIHARA T, YASUDA I, ISAYAMA H, et al. Diagnostic and therapeutic single-operator cholangiopancreatoscopy in biliopancreatic diseases: Prospective multicenter study in Japan[J]. World J Gastroenterol, 2016, 22(5): 1891-1901. DOI: 10.3748/wjg.v22.i5.1891.
[4]	FRANZINI T, CARDARELLI-LEITE L, FIGUEIRA E, et al. SpyGlass percutaneous transhepatic cholangioscopy-guided lithotripsy of a large intrahepatic stone[J]. Endoscopy, 2017, 49(12): e292-292e293. DOI: 10.1055/s-0043-117943.
[5]	ABURAJAB M, DUA K. Endoscopic management of difficult bile duct stones[J]. Curr Gastroenterol Rep, 2018, 20(2): 8. DOI: 10.1007/s11894-018-0613-1.
[6]	WONG JC, TANG RS, TEOH AY, et al. Efficacy and safety of novel digital single-operator peroral cholangioscopy-guided laser lithotripsy for complicated biliary stones[J]. Endosc Int Open, 2017, 5(1): e54-e58. DOI: 10.1055/s-0042-118701.
[7]	LALEMAN W, VERRAES K, van STEENBERGEN W, et al. Usefulness of the single-operator cholangioscopy system SpyGlass in biliary disease: A single-center prospective cohort study and aggregated review[J]. Surg Endosc, 2017, 31(5): 2223-2232. DOI: 10.1007/s00464-016-5221-2.
[8]	COLOMBI D, ARAGONA G, BODINI FC, et al. SpyGlass percutaneous transhepatic cholangioscopy-guided diagnosis of adenocarcinoma of the ampullary region in a patient with bariatric biliopancreatic diversion[J]. Hepatobiliary Pancreat Dis Int, 2019, 18(3): 291-293. DOI: 10.1016/j.hbpd.2019.03.002.
[9]	YAN S, TEJASWI S. Clinical impact of digital cholangioscopy in management of indeterminate biliary strictures and complex biliary stones: A single-center study[J]. Ther Adv Gastrointest Endosc, 2019, 12: 2631774519853160. DOI: 10.1177/2631774519853160.
[10]	CHEN YK. Preclinical characterization of the Spyglass peroral cholangiopancreatoscopy system for direct access, visualization, and biopsy[J]. Gastrointest Endosc, 2007, 65(2): 303-311. DOI: 10.1016/j.gie.2006.07.048.
[11]	HAMMERLE CW, HAIDER S, CHUNG M, et al. Endoscopic retrograde cholangiopancreatography complications in the era of cholangioscopy: Is there an increased risk?[J]. Dig Liver Dis, 2012, 44(9): 754-758. DOI: 10.1016/j.dld.2012.04.024.
[12]	KALAITZAKIS E, WEBSTER GJ, OPPONG KW, et al. Diagnostic and therapeutic utility of single-operator peroral cholangioscopy for indeterminate biliary lesions and bile duct stones[J]. Eur J Gastroenterol Hepatol, 2012, 24(6): 656-664. DOI: 10.1097/MEG.0b013e3283526fa1.
[13]	DU L, D′SOUZA P, THIESEN A, et al. Percutaneous transhepatic cholangioscopy for indeterminate biliary strictures using the SpyGlass system: A case series[J]. Endoscopy, 2015, 47(11): 1054-1056. DOI: 10.1055/s-0034-1392527.
[14]	XU W, MIAO L, WANG ZF, et al. Application of SpyGlass TM DS direct visualization system in the diagnosis and treatment of biliary tract diseases[J]. J Clin Hepatol, 2020, 36(11): 2626-2629. DOI: 10.3969/j.issn.1001-5256.2020.11.052. 徐雯, 苗龙, 王正峰, 等. SpyGlass TM DS直视化系统在胆道疾病诊疗中的应用[J]. 临床肝胆病杂志, 2020, 36(11): 2626-2629. DOI: 10.3969/j.issn.1001-5256.2020.11.052.