SpyGlass直视下激光碎石在困难胰管结石中的应用 （含视频）

评估 SpyGlass直视下激光碎石在困难胰管结石中的应用。收集2018年1月—2020年4月在山东省立第三医院因困难胰管结石行SpyGlass直视下激光碎石的患者资料。共有18例患者纳入研究,每例行经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP) (1.5±0.7)次。碎石操作成功率为88.9%（16/18）,16例患者每例SpyGlass碎石（1.3±0.4）次。结石直径为（13.17±3.69） mm,结石个数为（1.70±0.74）个。9例患者结石位于胰头,15例患者伴胰管近端狭窄。1例患者发生ERCP术后胰腺炎,无出血、穿孔等并发症发生。胰管支架留置时间为（10.5±2.8）个月,术后随访6~30个月,胰管狭窄及胰管结石无复发。SpyGlass内镜直视下行激光碎石在困难胰管结石中是安全有效的。     

SpyGlass内镜直视系统下激光碎石在巨大胆总管结石中治疗的作用

目的：评估SpyGlass内镜直视系统（SpyGlass）联合激光碎石治疗胆总管巨大结石（直径>2cm）的有效性与安全性。 方法：收集2012.9-2017.8期间因巨大胆管结石而在我院行SpyGlass联合激光碎石治疗的患者,统计分析取石成功率和并发症发生率。 结果：共有15位符合条件的胆管巨大结石患者进行了SpyGlass联合激光碎石术,其中7例患者为单颗巨大结石,8例患者为多发巨大结石,一次取石成功率为73.3%(11/15),二次取石成功率为26.7%(4/15),总结石清除率100%;无出血、感染、穿孔等并发症发生,并发症发生率为0%（0/15）。 结论：SpyGlass联合激光碎石治疗巨大胆管结石安全且有效,值得推广应用。 关键词：巨大胆总管结石,SpyGlass, 激光碎石     

SpyGlass内镜直视系统在不明原因 胆道狭窄诊断中的价值

目的评估SpyGlass内镜直视系统(以下简称SpyGlass)对不明原因胆道狭窄的诊断价值。方法收集2012年9月至2017年8月期间因不明原因胆道狭窄在杭州市第一人民医院行SpyGlass检查的患者资料,统计分析SpyGlass诊断不明原因胆道狭窄的准确性。结果共有88例不明原因胆道狭窄患者接受了SpyGlass检查,操作成功率97.7%(86/88),SpyGlass视觉诊断不明原因胆道狭窄良恶性的灵敏度为98.1%(52/53),特异度为96.9%(31/32),准确率为97.6%(83/85),阳性预测值为98.1%(52/53),阴性预测值为96.9%(31/32)。3例(3.5%,3/86)患者术后出现相关并发症,均经内科保守治愈。结论SpyGlass对于不明原因胆道狭窄诊断具有很高的灵敏度和准确率,并发症发生率低,安全有效。     

SpyGlass内镜直视系统在胆胰管狭窄及胆管巨大结石中的诊治作用

目的 评估SpyGlass内镜直视系统对胆管、胰管狭窄的性质判断及胆管巨大结石的诊治效果。方法 收集2012年9月—2018年8月期间因不明原因胆管、胰管狭窄或胆管巨大结石在杭州市第一人民医院行SpyGlass诊治的患者资料。采用SpyGlass视觉诊断不明原因胆胰管狭窄,部分患者行Spybite活检;胆管巨大结石采用SpyGlass直视联合激光碎石治疗。分析SpyGlass诊治的操作成功率、临床成功率和并发症发生率。结果 共114例胆管狭窄、11例胰管狭窄和19例胆管巨大结石患者接受了SpyGlass诊治,总操作成功率为98.6%（142/144）。SpyGlass视觉诊断不明原因胆管狭窄性质的灵敏度、特异度、准确率、阳性预测值和阴性预测值分别为97.1％（67/69）、95.3％（41/43）、96.4%（108/112）、97.1％（67/69）和95.3％（41/43）。SpyGlass视觉诊断不明原因胰管狭窄性质的准确率为100.0%(11/11)。19例巨大胆管结石患者的碎石率为89.5%（17/19）,首次取石成功率为73.7%(14/19),5例首次取石失败的患者二次取石均成功,总取石成功率为100.0%（19/19）。共4例（2.8%）患者出现术后并发症,其中急性胆管炎3例、轻症急性胰腺炎1例。结论 SpyGlass诊断不明原因胆管、胰管狭窄准确、安全;SpyGlass联合激光碎石治疗胆管巨大结石安全、有效。     

SpyGlass直视下激光碎石术与腹腔镜胆总管探查术治疗胆总管巨大结石的非劣效对照

目的评价SpyGlass直视下激光碎石术治疗胆总管巨大结石（直径＞2 cm）的临床疗效及安全性。方法2015年8月—2018年8月,山东第一医科大学第一附属医院收治的157例胆总管巨大结石患者纳入研究,采用随机数字随机分入SpyGlass组（78例）或腹腔镜胆总管探查术（laparoscopic common bile duct exploration,LCBDE）组（79例）,SpyGlass组采用SpyGlass直视下激光碎石术治疗,LCBDE组采用LCBDE治疗。主要观察结石取净率和一次性结石取净率,非劣效检验的非劣效界值设为10%。次要观察指标包括中转率、短期并发症发生率、住院时间、患者生活质量（采用胃肠道生活质量指数评分）。结果结石取净率SpyGlass组和LCBDE组分别为92.3%（72/78）和96.2%（76/79）（P=0.023）,非劣效假设成立;一次性结石取净率SpyGlass组和LCBDE组分别为83.3%（65/78）和96.2%（76/79）（P=0.124）,非劣效假设不成立。与LCBDE组比较,SpyGlass组中转率略高[7.7%（6/78）比3.8%（3/79）,P=0.294],短期并发症总体发生率略低[5.1%（4/78）比10.1%（8/79）,P=0.246],住院时间更短[（5.65±0.94）d比（8.84±1.54）d,P=0.001],术后1个月、术后3个月胃肠道生活质量指数评分更高[术后1个月：（99.85±4.36）分比（91.51±5.47）分,P=0.001;术后3个月：（131.24±3.32）分比（112.32±7.77）分,P=0.001]。结论对于胆总管巨大结石,SpyGlass直视下激光碎石的疗效不劣于LCBDE,且更加微创,可作为LCBDE之外的治疗胆总管巨大结石的重要选择。     

胆道镜在胆管结石治疗中的作用

我院自1997年8月-2002年5月,应用胆道镜治疗胆管结石256例,现报告如下。 1.一般资料:本组男81例,女175例;年龄22-78岁,平均47.5岁;肝内胆管结石(包括合并胆总管结石)91例,胆总管结石165例;术中胆道镜治疗(intraoperative choledo-     

SpyGlass经口胆道镜在肝移植术后胆道狭窄诊治中的应用

探讨肝移植术后胆道狭窄在经口胆道镜（SpyGlass）下的表现及SpyGlass在困难狭窄中的治疗作用。方法　2019年1月—2020年12月就诊于西安交通大学第一附属医院肝胆外科的24例肝移植术后胆道狭窄患者,术后15.5个月（2~58个月）接受SpyGlass检查。记录并分析不同类型胆道狭窄在SpyGlass镜下表现及困难胆道狭窄SpyGlass引导下的导丝超选结果。结果　24例患者中,9例为胆道吻合口狭窄（anastomostic stricture,AS）,15例为非吻合口狭窄（non?anastomostic stricture,NAS）。5例初治AS镜下的主要表现为瘢痕性缩窄。15例NAS无论是否初治,镜下肝门部胆管呈明显炎性增生改变,80%（12/15）合并肝内胆管结石。8例脱支架者（AS和NAS各4例）镜下狭窄消失伴局部轻度炎性增生。11例（AS 5例,NAS 6例）需SpyGlass直视下放置导丝,共6例（54.5%）成功,其中AS成功率（4/5）高于NAS（2/6）。结论　肝移植术后AS主要表现为瘢痕性缩窄,NAS主要为炎性增生,困难AS SpyGlass镜下超选具有较高的成功率。     

胆道镜在胆总管探查术中的应用体会

传统胆总管探查术是治疗胆管结石有效的手段,但术后残余结石率高达30%以上,它存在很高的盲目性.2001～2005年,我们应用Olympus CHF-P20型纤维胆道镜行胆总管探查术106例,效果较好.现报告如下.     

新型SpyGlass经口胆道镜对性质不明胆管狭窄的诊断价值

目的探讨数字式经口胆道镜在诊断性质不明胆管狭窄中的价值。方法回顾性分析2018年1月—2019年1月期间,在海军军医大学附属东方肝胆外科医院采用第二代SpyGlass评估的66例胆管狭窄患者的临床资料,观察胆管狭窄的影像特点及类型,以病理和长期随访结果为金标准,评估SpyGlass视觉印象的敏感度、特异度、阳性预测值和阴性预测值。结果根据病理、其他影像以及长期随访的结果,20例患者被确诊为胆管良性狭窄,46例为恶性肿瘤。SpyGlass视觉印象的诊断敏感度为100.0% (46/46),特异度为90.0% (18/20),阳性预测值为95.8% (46/48),阴性预测值为100.0% (18/18)。SpyGlass下病变部位发现不规则血管或质地松脆易出血是恶性狭窄最为常见的表现。结论新一代SpyGlass系统能够对多数良、恶性胆管狭窄进行影像特征评估,具有较高的敏感度。     

Current status of peroral cholangioscopy in biliary tract diseases

Peroral cholangioscopy(POC) is an important tool for the management of a selected group of biliary diseases. Because of its direct visualization, POC allows targeted diagnostic and therapeutic procedures. POC can be performed using a dedicated cholangioscope that is advanced through the accessory channel of a duodenoscope or via the insertion of a small-diameter endoscope directly into the bile duct. POC was first described in the 1970 s, but the use of earlier generation devices was substantially limited by the cumbersome equipment setup and high repair costs. For nearly ten years, several technical improvements, including the single-operator system, high-quality images, the development of dedicated accessories and the increased size of the working channel, have led to increased diagnostic accuracy, thus assisting in the differentiation of benign and malignant intraductal lesions, targeting biopsies and the precise delineation of intraductal tumor spread before surgery. Furthermore, lithotripsy of difficult bile duct stones, ablative therapies for biliary malignancies and direct biliary drainage can be performed under POC control. Recent developments of new types of conventional POCs allow feasible, safe and effective procedures at reasonable costs. In the current review, we provide an updated overview of POC, focusing our attention on the main current clinical applications and on areas for future research.     

Peroral cholangioscopy for the diagnosis and treatment of biliary diseases

Peroral cholangioscopy with duodenoscopic assistance can allow direct visualization of the bile duct. Several clinical studies suggest the utility of peroral cholangioscopy for the management of various bile duct lesions. Although direct visual observation may be a useful adjunct to endoscopic retro-grade cholangiopancreatography (ERCP) for distinguishing malignant from benign bile duct lesions, the assessment of diagnostic accuracy needs further controlled clinical studies. Intracorporeal lithotripsy with the use of a peroral cholangioscope may be a safe and effective method for difficult-to-treat bile duct stones, including intrahepatic stones. At present, however, the fragility of the fiberscope equipment and technical difficulties hold back its popularity. Preliminary data obtained by using a new videoscope, which provides excellent quality images, are encouraging. Furthermore, it is expected that this videoscope will have longer durability of optical images and better manipulation than previous fiberscopes.     

Role of digital single-operator cholangioscopy in the diagnosis and treatment of biliary disorders

Due to the need for improvement in the diagnosis and minimally invasive therapy of the bile duct disorders new technologies for cholangioscopy have been recently developed. Per-oral cholangioscopy has become an important diagnostic and therapeutic tool leading to avoidance of aggressive and unnecessary surgery in many clinical scenarios. This paper focuses on the newly developed SpyGlass DS technology, its advantages, and the technique of single-operator cholangioscopy(SOC), biliary indications and possible adverse events. We also review the available literature; discuss the limitations and future expectations.Digital SOC(D-SOC) is a useful technique, which provides endoscopic imaging of the biliary tree, optical diagnosis, biopsy under direct vision and therapeutic interventions. The implementations are diagnostic and therapeutic. Diagnostic indications are indeterminate biliary strictures, unclear filling defects, staging of cholangiocarcinoma, staging of ampullary tumors(extension into the common bile duct), unclear bile duct dilation, exploring cystic lesions of the biliary tree,unexplained hemobilia, posttransplant biliary complications. Therapeutic indications are lithotripsy of difficult stones, retrieval of migrated stents, foreign body removal, guide wire placement, transpapillary gallbladder drainage and endoscopic tumor ablative therapy. Most studied and established indications are the diagnosis of indeterminate biliary stricture and intraductal lithotripsy of difficult stones. The adverse events are not different and more common compared to those of Endoscopic retrograde cholangiopancreatography(ERCP)alone. D-SOC is a safe and effective procedure, adjunct to the standard ERCP and the newly available digital technology overcomes many of the limitations of the previous generations of cholangioscopes.     

Early Detection of High-grade Biliary Intraepithelial Neoplasia (BilIN-3) in the Cystic Duct Visualized by SpyGlass DS Cholangioscopy

An 84-year-old man was admitted with epigastralgia. Computed tomography showed contrast-enhanced wall thickness in the cystic duct. An endoscopic examination revealed short irregular stricture in the cystic duct, and per-oral cholangioscopy revealed a reddish papillary tumor at the stricture site. Surgical resection revealed high-grade biliary intraepithelial neoplasia (BilIN) at the stricture site of the cystic duct. To our knowledge, this is the first case of a solitary high-grade BilIN epithelium in the cystic duct detected by per-oral cholangioscopy.