针状刀在急性化脓性胆管炎治疗中的应用

Application of needle-knife precut sphincterotomy in treating acute suppurative cholangitis

目的探讨经内镜针状刀乳头括约肌切开术(PST)治疗急性化脓性胆管炎的应用价值。方法对有结石嵌顿、炎性狭窄的乳头做常规逆行胰胆管造影术(ERCP)乳头插管失败后,进行针状刀电切,找到胆总管下端开口,成功后改用常规电刀切开或乳头气囊扩张,再行网篮取石、置管引流等。结果12例患者中11例取石成功,取石成功率为91.7%。结论乳头结石嵌顿、乳头炎性狭窄伴结石致急性化脓性胆管炎,在常规内镜乳头插管困难时,采用PST技术,患者可以得到有效的诊断和治疗。PST是内镜下治疗结石源性急性化脓性胆管炎的重要手段。

Objective To evaluate the application of endoscopic needle - knife precut sphincterotomy （PST） in treating acute suppurative cholangitis. Methods After failure of routine papillary intuhation during encoscopic retrograde cholangio - pancreatography （ERCP） in papillary incarcerated stone or inflammatory stenosis cases, needle - knife PST was applied to find the lower opening of the common bile duct. After that, routine papillary sphincterotomy or balloon dilation followed. Then net basket for stone extraction and nasobiliary catheter for drainage were made. Results Eleven of the 12 cases＇ stones were extracted successfully, the success rate was 91.7%. In the 11 cases, 5 cases＇ incarcerated stones dropped into duodenum automatically after sphinctcrotomy; 9 cases＇ stones were extracted successfully in one treatment while 2 cases＇ stones were extracted secondarily after stents were implanted; 1 case＇s stone could not be extracted and need surgical treatment after nasobiliary catheter drainage because of stenosis of the lower part of the common bile duct. There was no dead case in all the cases. Conclusions Acute suppurative cholangitis patients, who have papillary incarcerated stones or inflammatory stenosis, can receive more efficacious diagnosis and treatment by applying PST when routine endoscopic papillary intuhation fails. PST is an important endoscopic treatment for acute calculous suppurative cholangitis