摘要目的 探讨胆道镜下高频电切治疗胆肠吻合术后吻合口狭窄的疗效及安全性. 方法 回顾性分析2011年12月至2013年12月我科采用胆道镜下高频电切治疗13例胆肠吻合术后吻合口狭窄患者的临床资料.术中胆道镜直视下观察及镜下造影证实患者胆肠吻合口狭窄,从胆道镜器械孔插入高频针状电切刀,电切刀头进入吻合口内将吻合口处组织切开.结果 4例患者直接实施胆道镜下高频电切术,6例患者因结石堵塞肝门部胆管致球囊扩张导管置管失败而行电切术,3例患者因球囊扩张后膜状狭窄未解除而行电切术;电切术平均操作时间为13.5 min(5～25 min),切开过程中发生吻合口渗血3例,采取针状刀高频电凝成功止血,未发生肠漏、再出血等并发症;电切术后6例患者因存在胆肠吻合口相对狭窄,再行球囊扩张术;所有患者均取净肝内外胆管结石并放置支撑管.随访13例,时间1～4年,术后吻合口狭窄复发3例,采取经皮肝穿刺后持续性球囊扩张6个月后解除.结论 胆道镜下高频电切术是治疗胆肠吻合口狭窄的一种简单、安全、有效的方法,尤其适用于球囊导管扩张失败患者.

abstractsObjective To investigate the efficacy and safety of endoscopic high frequency electrotomy for bile duct anastomotic stricture after choledochojejunostomy.Method The clinical data of 13 cases of bile duct anastomotic strictures after choledochojejunostomy from December 2011 to December 2013 were retrospectively analyzed.After bile duct anastomotic stricture was confirmed with choledochoscope and cholangiography,a high-frequency needlelike electric knife was inserted into the anastomotic stoma from the hole of choledochoscope to cut the tissue around the stoma.Result 4 cases received endoscopic high frequency electrotomy.6 cases received electrotomy after a failure of balloon dilatation for stones blocking the hilar bile duct.3 cases received electrotomy for unsolved membranous stenosis after balloon dilation.The average operating time of electrotomy was 13.5 minutes (range,5-25 minutes).anastomotic stoma tissue bleeding occurred in 3 cases,which were cured with endoscopic high frequency electric cautery.6 cases received balloon dilatation for relative anastomotic stricture.Support tubes were placed until there was no residual stone.13 cases were followed up for 1-4 years,anastomotic stricture recurred in 3 cases and cured by percutaneously persistent balloon dilatation for 6 months.Conclusions Endoscopic high frequency electrotomy is a simple,safe and effective method for bile duct anastomotic stricture after choledochojejunostomy.It is especially suitable for balloon dilatation failure patients.