微创医学

目的探讨透明帽辅助胃镜在毕罗Ⅱ式胃大部切除术后合并胆管疾病患者的ERCP内镜治疗经验。方法11例毕罗Ⅱ式胃大部切除术后合并胆管疾病患者选择透明帽辅助胃镜ERCP，插管成功者行EST和（或）EPBD、ENBD、ERBD及EMBE等治疗。结果所有病例在毕罗Ⅱ式胃大部切除术后均插管造影成功（100%），其中9例胆总管结石分别行EST 7例、EPBD 2例，胆总管结石取净率100%；胆管癌1例行EMBE，胆道手术后胆管狭窄1例行ERBD，均顺利完成。ESD术后高淀粉酶血症1例，未发生胰腺炎、消化道穿孔和大出血等严重并发症。结论透明帽辅助胃镜在毕罗Ⅱ式合并胆管疾病的ERCP诊治中有助于空肠袢内的进镜，便于胆管插管及结石的清除，提高ERCP的成功率，减少严重并发症的发生。

ObjectiveTo explore the treatment experience of transparent Cap assisted gastroscopy in endoscopic retrograde cholangiopancreatography (ERCP)of biliary tract diseases after Billroth Ⅱgastrectomy. Methods11 patients with biliary tract diseases who had previously undergone a Billroth Ⅱgastrectomy were diagnosed and treated by using Cap assisted forwardviewing gastroscopy, including ERCP, endoscopic sphincterotomy (EST), endoscopic papillary balloon dilatation (EPBD), endoscopic nasobiliary drainage (ENBD), endoscopic retrograde biliary drainage (ERBD), and endoscopic metal biliary endoprothesis(EMBE). ResultsOf 11 patients in whom ERCP was attempted, afferent loop intubation and selective bile duct cannulation were achieved in all patients (100%), 9 with common bile duct stones were treated successful by EST in 7 patients and endoscopic papillary balloon dilation in 2 patients;1 with bile duct can cers was treated by EMBE; and 1 with postoperative common bile duct stenosis was treated by ERBD. All stones were removed successful (100%).There was no serious complications in the patients. One patient treated by EST had complication of transient hyperamylasemia but relieved soon after medical treatment. Al1the patients had no complications of pancreatitis, perforation, or hemorrhage caused by endoscopic management. ConclusionsCapassisted gastroscopic treatment conduces to afferent loop intubation and bile duct cannulation, thus raise the success rate of ERCP, as well as decrease the occurrence of serious complication in patients with biliary tract diseases after a Billroth Ⅱgastrectomy