Objective The present study was to probe the value of endoscopic retrograde cholangiography (ERC) through jejunostomy in patients in whom ERC could not ba performed via the mouth after Roux-en-Y anastomosis on the upper gastrointestinal tract. Methods In two patients were suffering from acute obstructive suppurative cholangitis after a radical operation for cholangiocarcinoma, ERC could not done through the mouth due to the presence of a long non-functional intestinal loop. A jejunostomy was first done in the afferent loop of the jejunam. A gastroscope was then inserted via the jejunostomy, and it was passed retrogradely, to find the stoma of the cholangio-intestinal anastomosis. ERC was then successfully performed, and it was followed by endoscopic retrograde biliary drainage (ERBD). Results The operation was successful. It was found that cholangio-jejunostomy stoma was narrow, and a large amount of purulent mucus was present in the enlarged intrahepatic duct. ERC was done to enlarge the stoma, and a stent was placed into the main branch of the intrahepatic duct. The operation was successfully done in two patients, and they recovered smoothly after the operation. Conclusion ERC through a jejunostomy in patients who had had Roux-en-Y cholangio-jejunostomy following radical resection for cholangiocarcinoma, is a safe and effective surgical procedure.%目的 探讨上消化道重建术后患者无法经口完成内镜逆行胆管造影术(ERC)时经腹壁入路小肠造瘘ERC的价值.方法 2例胆管癌根治术后再发急性梗阻性化脓性胆管炎患者,因无功能空肠襻迂曲、过长,无法完成经口ERC,先行腹壁切开找到输入襻小肠造瘘,自瘘口送入胃镜,沿无功能空肠襻逆行进镜找到胆肠吻合口,行ERC并胆管支架置入术(ERBD).结果 行腹壁切开并成功于无功能空肠襻小肠造瘘,经造瘘口沿空肠襻逆行进镜发现胆肠吻合口狭窄,肝内胆管可见大量脓性黏液,遂扩张吻合口行ERC,并于扩张的肝内胆管主要分支内置入支架,患者术后恢复顺利.结论 胆管癌根治、Roux-en-Y上消化道重建术后患者罹患胆管疾病无法经口完成ERC时,经腹壁入路小肠造瘘逆行进镜行诊断及治疗性ERC是安全、有效的方法.
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