探讨十二指肠侧视镜引导下ERCP在消化道重建术后胆胰疾病诊疗中的可行性及安全性。

回顾性分析2014年1月至2021年3月在西安交通大学第一附属医院行ERCP治疗的45例消化道重建术后并发胆胰疾病患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男32例，女13例；年龄48~73岁，中位年龄65岁。既往消化道重建手术包括毕Ⅰ式胃大部分切除术3例，毕Ⅱ式胃大部分切除术32例，胰十二指肠切除术（Whipple术）6例，胃-空肠Roux-en-Y吻合术4例。采用十二指肠侧视镜引导下ERCP进行诊治。分析ERCP进镜成功率、进镜时间、插管成功率、插管时间、术后并发症等。

毕Ⅰ式胃大部分切除术后患者进镜成功率为3/3，中位进镜时间为15（13~25）min；插管成功率为3/3，插管时间为14（4~16）min。毕Ⅱ式胃大部分切除术后患者进镜成功率为91%（29/32），进镜时间为35（26~48）min；插管成功率为93%（27/29），插管时间为26（11~42）min；其中2例进镜失败患者行超声内镜（EUS）下胆道穿刺引流。Whipple术后患者进镜成功率为6/6，进镜时间为106（46~177）min；插管成功率为3/6，插管时间为28（15~52）min。胃-空肠Roux-en-Y吻合术后患者进镜成功率为2/4，进镜时间为38（30~63）min；插管成功率为2/2，插管时间为20（20~36）min；2例进镜失败患者行EUS下肝胃吻合术。所有患者总体进镜成功率为89%（40/45），进镜时间为35（13~177）min；总体插管成功率为88%（35/40），插管时间为27（4~52）min。术后发热3例，不明原因消化道出血1例，高淀粉酶血症2例，无发生严重并发症。

采用十二指肠侧视镜引导下ERCP治疗消化道重建术后胆胰疾病患者是安全、可行的，EUS下胆道穿刺引流可作为消化道重建术后ERCP失败的补救措施。

To evaluate the feasibility and safety of duodenoscopy-guided ERCP in the diagnosis and treatment of biliary and pancreatic diseases after digestive tract reconstruction.

Clinical data of 45 patients with biliary and pancreatic diseases after digestive tract reconstruction who underwent ERCP in the First Affiliated Hospital of Xi'an Jiaotong University from January, 2014 to March, 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 32 patients were male and 13 female, aged from 48 to73 years, with a median age of 65 years. History of digestive tract reconstruction surgeries included BillrothⅠ subtotal gastrectomy in 3 cases, Billroth Ⅱ subtotal gastrectomy in 32, pancreaticoduodenectomy (Whipple) in 6 and Roux-en-Y gastrojejunostomy in 4, respectively. Duodenoscopy-guided ERCP was performed for the diagnosis and treatment. The success rate and time of ERCP insertion, success rate and time of intubation and postoperative complications were analyzed.

The success rate of ERCP insertion was 3/3 in patients after Billroth Ⅰ subtotal gastrectomy, and the median time of ERCP insertion was 15(13-25) min. The success rate of intubation was 3/3, and the intubation time was 14(4-16) min. In patients after Billroth Ⅱ subtotal gastrectomy, the success rate of ERCP insertion was 91%(29/32), and the time of ERCP insertion was 35(26-48) min. The success rate of intubation was 93%(27/29), and the intubation time was 26(11-42) min.Among them, ERCP insertion was failed in 2 cases who subsequently underwent endoscopic ultrasound (EUS)-guided biliary tract puncture and drainage. The success rate of ERCP insertion was 6/6 in patients after Whipple, and the time of ERCP insertion was 106(46-177) min. The success rate of intubation was 3/6, and the intubation time was 28(15-52) min. The success rate of ERCP insertion in patients afterRoux-en-Y gastrojejunostomy was 2/4, and the time of ERCP insertion was 38(30-63) min. The success rate of intubation was 2/2, and the intubation time was 20(20-36) min. 2 patients with failure of ERCP insertion received EUS-guided hepatogastric anastomosis. For all patients, the overall success rate of ERCP insertion was 89%(40/45), and the time of ERCP insertion was 35(13-177) min. The overall success rate of intubation was 88%(35/40), and the intubation time was 27(4-52) min. Postoperatively, 3 cases developed fever,1 presented with gastrointestinal bleeding with unknown cause and 2 experienced hyperamylasemia. No severe complications were reported.

It is safe and feasible to perform duodenoscopy-guided ERCP for patients with biliary and pancreatic diseases after digestive tract reconstruction. EUS-guided biliary drainage can be employed as a remedial procedure for ERCP failure after digestive tract reconstruction.