病例报告利用腔内并置金属支架建立内镜
Lumen-ApposingMetalStentfortheCreationofanEndoscopicDuodenojejunostomytoFacilitateBileDuctClearanceFollowingRoux-en-YHepaticojejunostomy
利用腔内并置金属支架建立内镜下十二指肠空肠吻合口，从而清除Roux-en-Y肝管空肠吻合术后的胆管结石
OlayaI.BrewerGutierrez1,ThomasRunge,YervantIchkhanian,KiaVosoughi,MouenA.Khashab
作者机构：1.JohnsHopkinsMedicalInstitutions约翰霍普金斯大学医学院
Endoscopy;Publishedtime:24July
DOI:10./a--
A52-year-oldwomanwithhistoryofbileductinjuryfollowingcholecystectomyandpreviousRoux-en-Yhepaticojejunostomywasadmittedbecauseofcholangitis.Herwork-uprevealeda7-mmstoneintherightintrahepaticductonmagneticresonancecholangiopancreatography(MRCP).Aninitialsingle-balloonenteroscopy-assistedendoscopicretrogradecholangiopancreatography(ERCP)revealedindependentrightandlefthepaticojejunostomiesandbilateralstrictures.Alargerightintrahepaticfillingdefectwasidentifiedonanocclusioncholangiogram(?Fig.1).Bilateraldilationoftheanastomosiswasperformedwithan8-mmhydrostaticballoon,butthestonecouldnotberemovedandtwoplasticbiliarystents(7F×5cm)wereplaced.
患者，女，52岁，胆囊切除术后胆管曾受到损伤，具有既往Roux-en-Y肝管空肠吻合术史，因胆管炎入院。磁共振胰胆管造影（MRCP）检查显示，右肝内胆管有一块7mm的结石。初步单气囊小肠镜辅助的经内镜逆行性胰胆管造影术（ERCP）显示左肝管空肠吻合、右肝管空肠吻合和双侧狭窄。对梗阻部位进行胆管造影，显示右肝内胆管有一个较大的充盈缺损（?图1）。利用一个8mm的注水球囊进行吻合口双侧扩张，但结石并未取出，所以放置了两个塑料胆道支架（7F×5cm）。
Fig.?1?Occlusioncholangiogramduringenteroscopy-assistedendoscopicretrogradecholangiopancreatographyshowingalargerightintrahepaticfillingdefect.
图1.小肠镜辅助的ERCP中梗阻部位胆管造影显示较大的右肝内胆管充盈缺损。
Contrastinjectionintothebiliopancreaticlimbshowedthatitwascloselyapproximatedtotheduodenalbulbandthereforesuitableforanendoscopicultrasound(EUS)-guidedduodenojejunostomy(EUS-DJ)tofacilitateaccesstotheafferentlimband
