超声内镜下胆道引流对外科术后解剖结构改变患者恶性梗阻性黄疸的治疗探讨

目的评估超声内镜引导下胆道引流术(EUS-BD)对外科术后解剖结构改变患者并发恶性梗阻性黄疸的可行性及安全性。方法选取2017年1月-2019年3月外科术后解剖异常伴发恶性胆道梗阻行EUS-BD的患者14例,评估治疗效果及术后短期并发症。结果14例中成功13例,技术成功率为92.86%,成功的13例中,9例行经肝顺行胆管支架引流,1例行经胃经肝内胆管穿刺造瘘术,1例行经胃经食道肝内胆管穿刺造瘘术,2例行经肝经空肠胆道穿刺造瘘术。术后1例发生消化道穿孔,1例发生胆汁性腹膜炎,1例出现贲门黏膜撕裂伴出血,均予以保守治疗好转,术后未发生支架移位。术后患者胆红素较术前明显下降,并顺利出院。结论在有经验的内镜中心,对外科术后解剖改变并发恶性胆道梗阻的患者实施EUS-BD是安全可行的。

Endoscopic ultrasonography-guided biliary drainage for malignant obstructive jaundice in patients with surgically altered anatomy

Objective To evaluate the feasibility and safety of endoscopic ultrasonography-guided biliary drainage(EUS-BD)for malignant biliary obstruction in patients with surgically altered anatomy.Methods From January 2017 to March 2019,14 malignant biliary obstruction patients with surgically altered anatomy underwent EUS-BD,and the treatment effect and short-term complications after surgery were evaluated.Results Of the 14 patients,13 were successfully underwent EUS-BD,and the technical success rate was 92.86%.Of the 13 successful patients,9 patients underwent EUS-guided antegrade biliary stenting,1 underwent hepaticogastrostomy,1 underwent hepaticoesophagostomy and 2 underwent hepaticojejunostomy.Postoperative complications included 1 patient with gastrointestinal perforation,1 patient with biliary peritonitis,1 patient with Mallory-Weiss syndrome with bleeding.All of them were improved after conservative treatment.No stent displacement occurred postoperatively.Compared with postoperative level of bilirubin,the level of bilirubin of patients decreased significantly after surgery and patients were discharged uneventfully.Conclusion It is safe and feasible to perform EUS-BD in experienced endoscopic centers for malignant biliary obstruction patients with surgically altered anatomy.