超声内镜引导下胆道引流治疗2例胆道梗阻患者

时间:2018-12-28 作者:翻译:李国富 审校: 点击:580次

超声内镜引导下胆道引流治疗2例胆道梗阻患者
 
介绍:
内镜逆行胰胆管造影是胆道引流的首选方法,虽然在某些情况下,进入胆道是很困难的,甚至是不可能的。在这些情况下,内镜超声(EUS)引导下的腔内手术可作为一种替代方案,虽然这个技术还不是十分成熟。
临床病例:
我们报告两个EUS引导下胆管引流的成功病例。第一个病例,是一位Ⅳ期胃腺癌行肝胃吻合术后的患者,由于门静脉的压迫,造成梗阻性黄疸,患者严重的胃狭窄和先前姑息性胃空肠造口妨碍十二指肠镜进入十二指肠第二段。第二个病例,一个胰头腺癌患者已经侵犯十二指肠,阻碍了探查主乳头而决定是否可行胆总管十二指肠造口术。两种手术均未发生直接或晚期的不良事件,具有技术和临床上的成功。
讨论:
尽管EUS引导下胆道引流的经验仍然有限,但与经皮和手术引流相比,其有效性和安全性是可以认可的,且应该认为EUS引导下胆道引流可以成为这些成熟技术的替代方法。
 
Endoscopic Ultrasound-Guided Biliary Drainage in Two Patients with Difficult Biliary Access.

Endoscopic Ultrasound-Guided Biliary Drainage in Two Patients with Difficult Biliary Access.

Diogo Libânio a, b Sílvia Giestas b David Martinez-Ares,et al. GE Port J Gastroenterol 2018;25:258–263
 

INTRODUCTION:

Endoscopic retrograde cholangiopancreatography is the method of choice for biliary drainage, although in some cases standard biliary access is difficult or even impossible. Endoscopic ultrasound (EUS)-guided endoluminal procedures are an alternative in these cases, although experience with these techniques is still limited.
CLINICAL CASE:
We present two cases of successful EUS-guided biliary drainage. In the first case, a hepaticogastrostomy was performed in a patient with stage IV gastric adenocarcinoma with obstructive jaundice due to compression of the hilum, where malignant gastric stenosis and previous palliative gastrojejunostomy precluded access to the second part of the duodenum. In the second case, a patient with a pancreatic head adenocarcinoma with duodenal invasion that precluded major papillae identification was submitted to a choledochoduodenostomy. Both procedures occurred without immediate or delayed adverse events, with technical and clinical success.
DISCUSSION:
Although experience with EUS-guided biliary drainage is still limited, its efficacy and safety is favorable when compared with percutaneous and surgical drainage, and should be considered an alternative to these techniques where sufficient expertise exists.

KEYWORDS:

Biliary drainage; Endoscopic retrograde cholangiopancreatography; Endoscopic ultrasonography; Gastrointestinal cancer; Palliative therapy

 翻译:李国富  审校:张立超、侯森林