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首页> 外文期刊>Surgical Endoscopy >Transhepatic balloon sphincteroplasty for bile duct stones after total gastrectomy.
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Transhepatic balloon sphincteroplasty for bile duct stones after total gastrectomy.

机译：全胃切除术后经肝球囊括约肌成形术治疗胆管结石。

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摘要

Previous upper gastrointestinal surgery with the construction of a Roux-en-Y jejunal loop may prevent endoscopic access to the second part of the duodenum. We report a technique of percutaneous transhepatic balloon sphincteroplasty to facilitate the removal of common bile duct (CBD) stones. A 67-year-old woman presented with a 1-week history of right upper quadrant abdominal pain and fever, deranged liver function tests, and dilated intrahepatic ducts. The patient had previously had a total gastrectomy with Roux-en-Y reconstruction for a high-grade B-cell lymphoma of the stomach. Peroral endoscopic access to the biliary tree was unsuccessful. Percutaneous transhepatic cholangiography confirmed the presence of CBD stones. Over a period of 8 weeks, sequential dilatation of the percutaneous tract was undertaken. After a further 2 weeks, percutaneous choledochoscopy was performed. Several large stones were visualized and then fragmented. The choledochoscope would not pass through to the duodenum due to postinflammatory stenosis of the papilla, so the papilla was dilated with an endoscopic balloon. The remaining fragments were pushed through, and the duct was thoroughly irrigated with saline. Repeat cholangiography confirmed a clear CBD. Balloon catheter sphincteroplasty and biliary stone extrusion into the duodenum is a novel technique that enabled clearance of the CBD in an elderly patient who may otherwise have required open surgical exploration.
机译：先前使用Roux-en-Y空肠环的上消化道手术可能会阻止内窥镜进入十二指肠的第二部分。我们报告了经皮经肝球囊括约肌成形术的技术，以促进胆总管（CBD）结石的清除。一名67岁的女性，有1周右上腹腹痛和发烧史，肝功能检查异常，肝内导管扩张。该患者先前接受了全胃切除术，并通过Roux-en-Y重建术治疗了胃高级B细胞淋巴瘤。经口内镜无法进入胆道树。经皮经肝胆道造影证实了CBD结石的存在。在8周的时间内，进行了经皮扩张。再过2周后，进行经皮胆道镜检查。观察了几块大石头，然后将其破碎。由于乳头炎后狭窄，胆道镜不会穿过十二指肠，因此用内窥镜球囊扩张乳头。将剩余的碎片推入，并用盐水彻底冲洗导管。重复胆道造影证实为清晰的CBD。球囊导管括约肌成形术和胆道结石挤压进入十二指肠是一种新技术，可以清除可能需要进行外科手术探查的老年患者中的CBD。

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