目的:探讨胃镜作为直接经口胆道内镜在胆管疾病诊治中的应用价值及安全性。方法:回顾性分析本院接受胃镜检查或治疗的胆管疾病患者36例的临床资料。本研究胃镜插入均为单纯徒手插入,详细记录进镜成功率、使用胃镜类型、十二指肠乳头切...目的:探讨胃镜作为直接经口胆道内镜在胆管疾病诊治中的应用价值及安全性。方法:回顾性分析本院接受胃镜检查或治疗的胆管疾病患者36例的临床资料。本研究胃镜插入均为单纯徒手插入,详细记录进镜成功率、使用胃镜类型、十二指肠乳头切开大小、球囊扩张大小、进入胆管的深度、内镜下诊断、术后并发症情况。结果:插入胆总管成功率94.4%(34/36),其中应用普通胃镜操作15例,超细胃镜操作19例;进入胆总管中下段15例,进入胆总管上段9例,进入左右肝管4例,进入肝内胆管6例。十二指肠乳头切开30例(大切开16例,中切开11例,小切口3例)。十二指肠乳头球囊扩张27例(球囊直径≤10 mm 5例,10 mm<球囊直径≤14 mm 14例,球囊直径>14 mm 8例)。确诊ERCP术后残留胆管结石12例,均在胃镜直视下成功清除残留结石;良性狭窄9例,恶性狭窄2例(活检证实"胆管癌、十二指肠乳头高分化腺癌");胆道出血2例,术中胃镜直视下行球囊扩张压迫止血或氩离子电凝止血成功;经胃镜胆道探查后未发现明显异常11例。并发症发生率35.3%(12/34),其中胆管炎2例、高淀粉酶血症5例、急性胰腺炎4例,均经内科治疗均痊愈;胆道穿孔1例经保守治疗后病情好转出院。结论:胃镜作为经口胆道镜诊治胆管疾病有较大临床价值和较好的安全性,但该技术仍存在一些少见的严重并发症,且对内镜医师操作技巧要求高,有待进一步研究改进。展开更多
胆管导管内乳头状黏液性肿瘤是一类起源于胆管黏膜上皮的肿瘤,临床罕见。其临床表现、实验室检查及常见的影像学检查不具备特异性,给疾病诊断带来了挑战。本文介绍了一例临床表现为胆管炎,常规影像学检查见胆管狭窄及扩张的患者,该患者...胆管导管内乳头状黏液性肿瘤是一类起源于胆管黏膜上皮的肿瘤,临床罕见。其临床表现、实验室检查及常见的影像学检查不具备特异性,给疾病诊断带来了挑战。本文介绍了一例临床表现为胆管炎,常规影像学检查见胆管狭窄及扩张的患者,该患者常规检查均未明确诊断,经内镜逆行胰胆管造影联合胆道镜可见黏液自十二指肠乳头溢出,直视下获取病理组织,最终明确诊断为胆管导管内乳头状黏液性肿瘤。这提示我们内镜逆行胰胆管造影联合胆道镜的价值,为临床诊疗提供一定的参考。Intraductal papillary mucinous neoplasm is a rare type of tumor originating from the epithelium of the bile duct. Its clinical manifestation, laboratory examination and common imaging examination do not have specificity, which result in a challenge to the diagnosis of the disease. This paper reports on a case of a patient with clinical manifestations of cholangitis and conventional imaging studies revealing biliary strictures and dilatations. The patient’s routine examinations failed to establish a definitive diagnosis. However, we employed endoscopic retrograde cholangiopancreatography (ERCP) combined with cholangioscopy to observe mucus spilling from the duodenal papilla and obtained pathological tissue under direct vision. The final diagnosis was intraductal papillary mucinous neoplasm of the bile duct. It implies that ERCP combined with choledochoscopy is valuable for clinical diagnosis and treatment.展开更多
文摘目的:探讨胃镜作为直接经口胆道内镜在胆管疾病诊治中的应用价值及安全性。方法:回顾性分析本院接受胃镜检查或治疗的胆管疾病患者36例的临床资料。本研究胃镜插入均为单纯徒手插入,详细记录进镜成功率、使用胃镜类型、十二指肠乳头切开大小、球囊扩张大小、进入胆管的深度、内镜下诊断、术后并发症情况。结果:插入胆总管成功率94.4%(34/36),其中应用普通胃镜操作15例,超细胃镜操作19例;进入胆总管中下段15例,进入胆总管上段9例,进入左右肝管4例,进入肝内胆管6例。十二指肠乳头切开30例(大切开16例,中切开11例,小切口3例)。十二指肠乳头球囊扩张27例(球囊直径≤10 mm 5例,10 mm<球囊直径≤14 mm 14例,球囊直径>14 mm 8例)。确诊ERCP术后残留胆管结石12例,均在胃镜直视下成功清除残留结石;良性狭窄9例,恶性狭窄2例(活检证实"胆管癌、十二指肠乳头高分化腺癌");胆道出血2例,术中胃镜直视下行球囊扩张压迫止血或氩离子电凝止血成功;经胃镜胆道探查后未发现明显异常11例。并发症发生率35.3%(12/34),其中胆管炎2例、高淀粉酶血症5例、急性胰腺炎4例,均经内科治疗均痊愈;胆道穿孔1例经保守治疗后病情好转出院。结论:胃镜作为经口胆道镜诊治胆管疾病有较大临床价值和较好的安全性,但该技术仍存在一些少见的严重并发症,且对内镜医师操作技巧要求高,有待进一步研究改进。
文摘胆管导管内乳头状黏液性肿瘤是一类起源于胆管黏膜上皮的肿瘤,临床罕见。其临床表现、实验室检查及常见的影像学检查不具备特异性,给疾病诊断带来了挑战。本文介绍了一例临床表现为胆管炎,常规影像学检查见胆管狭窄及扩张的患者,该患者常规检查均未明确诊断,经内镜逆行胰胆管造影联合胆道镜可见黏液自十二指肠乳头溢出,直视下获取病理组织,最终明确诊断为胆管导管内乳头状黏液性肿瘤。这提示我们内镜逆行胰胆管造影联合胆道镜的价值,为临床诊疗提供一定的参考。Intraductal papillary mucinous neoplasm is a rare type of tumor originating from the epithelium of the bile duct. Its clinical manifestation, laboratory examination and common imaging examination do not have specificity, which result in a challenge to the diagnosis of the disease. This paper reports on a case of a patient with clinical manifestations of cholangitis and conventional imaging studies revealing biliary strictures and dilatations. The patient’s routine examinations failed to establish a definitive diagnosis. However, we employed endoscopic retrograde cholangiopancreatography (ERCP) combined with cholangioscopy to observe mucus spilling from the duodenal papilla and obtained pathological tissue under direct vision. The final diagnosis was intraductal papillary mucinous neoplasm of the bile duct. It implies that ERCP combined with choledochoscopy is valuable for clinical diagnosis and treatment.
