Stent-Guided Sphincterotomy in Billroth Ⅱ Gastrectomy Patients

治療畢耳羅氏第二型胃切除患者應用膽道內置管導引內視鏡乳突切開術之經驗

林連福(Lien-Fu Lin) ； 蕭泉豹(Chuan-Pau Siauw) ； 童瑞欽(Jai-Chin Tung)

《中華民國消化系醫學雜誌》 14卷2期 (1997/06) Pp. 198-203

https://doi.org/10.6557/GJTb.199706_14(2).0002

摘要

內視鏡乳突切開術於BⅡ胃切除過病患會因其解剖構造改變而面臨較高之困難度。文獻上有不同方式及其成功率也有所不同。本文報告十例病患，先置放膽道內置管，再利用針型電刀施行乳突切開術。十例中八例成功，二例因無法選擇性進入總膽管(Selective deep CBD cannulation)而失敗。無併發症。本方法之優點為切開方向正確，因內置管之存在，可使胰管免以受損。

關鍵字

內視鏡乳突切開術 ； 畢耳羅氏第二型胃切除 ； 針形電刀 ； 膽道內置管

並列摘要

Endoscopic sphincterotomy (EST) in post Billroth Ⅱ (B Ⅱ) gastrectomy patients is difficult due to the anatomical change and reversed direction of duodenal papilla. Various methods have been described with variable success and limitations. One of the problems is the difficulty in controlling the correct direction of EST. We used needle knife sphincterotome (NKS), performing EST over a biliary stent in 10 cases (stent-guided EST). The control of the direction of EST was satisfactory: Of ten cases, 8 were successful; the remaining 2 were unsuccessful due to the inability to cannulate deeply into the common bile duct (CBD). No complications occurred. The advantages of stent-guided EST are 1: correct direction of EST, and 2: protection of pancreatic duct by the stent. This can be a useful alternative method for EST in B Ⅱ gastrectomy patients.

並列關鍵字

endoscopic sphincterotomy ； Biliroth Ⅱ gastrectomy ； needle knife sphincterotome ； biliary stent