经皮穿刺空肠-胆管取石术在胆肠吻合术后狭窄伴结石中的应用（附18例报告）

doi:10.3877/cma.j.issn.2095-5782.2023.02.003

中华介入放射学电子杂志 ›› 2023, Vol. 11 ›› Issue (02) : 113 -116. doi: 10.3877/cma.j.issn.2095-5782.2023.02.003

所属专题：经典病例；

非血管介入

经皮穿刺空肠-胆管取石术在胆肠吻合术后狭窄伴结石中的应用（附18例报告）

赵中海¹, 朱立东¹, 杨宁²^,^†(

)

^1. 100062　北京，北京市普仁医院普外科
^2. 100730　北京，北京协和医院介入科

收稿日期:2022-12-28 出版日期:2023-05-25
通信作者: 杨宁

Application of percutaneous jejunal puncture in the treatment of bile duct stones after choledochoenterostomy (Report of 18 cases)

Zhonghai Zhao¹, Lidong Zhu¹, Ning Yang²^,^†()

^1. Department of General Surgery, Beijing Puren Hospital, Beijing 100062
^2. Department of Radiology, Peking Union Medical College Hospital, Beijing 100730, China

Received:2022-12-28 Published:2023-05-25
Corresponding author: Ning Yang

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目的

探讨一种新颖的胆肠吻合术后狭窄伴结石的治疗方法。

方法

经皮肝穿胆管引流术（percutaneous transhepatic cholangial drainage，PTCD）控制胆系感染，CT下确定空肠的经皮穿刺部位，肠管充气状态下穿刺置入8.5F导管固定，1个月后经此窦道透视下取石网篮取出胆管取石，取净胆管结石后予14F引流管支撑胆肠吻合口1年。

结果

完成经皮穿刺空肠行胆道取石18例，17例通过一次或多次透视下取尽结石，1例经3次取石不尽后转空肠窦道胆道镜取石成功，未出现明显出血、肠瘘、胆瘘及腹腔感染等并发症。随访期内复查未见复发结石，胆肠吻合口通畅。

结论

经皮穿刺空肠-胆管取石术是一种实用可行的治疗胆肠吻合术后胆肠吻合口狭窄伴结石的方法，可局麻操作，安全性高，并发症少，对麻醉及全身状况要求低，适应证广泛。

关键词: 经皮穿刺空肠, 胆肠吻合术, 胆管结石

Objective

To explore a novel technique for stone extraction of bile duct stones after choledochoenterostomy.

Methods

Using PTCD to control the biliary infection. The site of percutaneous jejunum puncture was determined by CT. The jejunum was punctured in the dilated state, and 8.5F catheter was placed and fixed. After 1 month, take out the bile duct stones with the stone basket through this sinus under fluoroscopy. After removing the bile duct stones, give 14F drainage tube to support the choledochojejunostomy for 1 year.

Results

Removal of bile duct stones were performed in 18 cases by the way of percutaneous jejunal puncture. 17 cases were removed completely by one or more fluoroscopy, and 1 case was transferred to the jejunal sinus choledochoscopy after three times of incomplete stone extraction, without obvious complications such as hemorrhage, intestinal fistula, biliary fistula and abdominal infection. During the follow-up period, no stone was found, and the biliary and intestinal anastomosis was unobstructed..

Conclusions

Percutaneous jejunal puncture for removal of bile duct stones is a feasible,safe and effective method for the treatment of bile duct stones after choledochoenterostomy.

Key words: Percutaneous jejunal puncture, Choledochojejunostomy, Bile duct stones

图1 经皮空肠穿刺置管图像1A：箭头示腹壁定位器；1B：箭头示细针空肠穿刺；1C：箭头示空肠穿刺置管；1D：箭头分别指空肠穿刺管（细），PTCD穿刺管（粗）。

图2 经空肠窦道介入取石影像2A：造影显示胆管内结石情况；2B：球囊扩张胆肠吻合口；2C：透视下取石网篮取石。

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Application of percutaneous jejunal puncture in the treatment of bile duct stones after choledochoenterostomy (Report of 18 cases)

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Application of percutaneous jejunal puncture in the treatment of bile duct stones after choledochoenterostomy (Report of 18 cases)