经胰管括约肌切开与针刀切开胆总管219例

Pancreatic Sphincter Precutting and Needle-Knife Sphincterotomy in 219 Cases

目的:通过对比胰管括约肌切开和针刀切开的成功率和并发症发生率,探讨胰管括约肌切开获得胆总管通道的可行性和安全性。方法:对219例选择性胆总管插管失败的病人分别施行针刀切开(NK组n=113)或经胰管括约肌切开(PSP组n=106),分别统计两组切开方法的成功率和并发症发生率。结果:219例中有209例十二指肠乳头括约肌切开成功(95.4%),PSP组成功插管104/106例(98.1%),NK组成功插管105/113例(92.9%)。结论:同针刀切开相比,胰管括约肌切开术有较高的成功率和较低的并发症率,是一项安全、有效的预切开方法。

Objective To compare the success and the complication rates of needle-knife sphincterotomy and pancreatic sphincter precutting in achieving cannulation for otherwise inaccessible bile ducts, and to evaluate the efficacy and safety of pancreatic sphincter precutting. Methods A Total of 219 patients with inaccessible bile ducts underwent pre cut sphincterotomy either by needleknife sphincterotomy （n =113） or by pancreatic sphincter precutting （n = 106）. Results In 209 of the series （95.4%）, the bile duct was selectively cannulated after pre-cut sphincterotomy. The bile duct was cannulated in 104 of 106 （98.1%） patients randomized to pancreatic sphincter precutting and in 105 of 113 （92.9%） patients who underwent needle-knife sphincterotomy. Conclusions Compared with standard needle- knife sphincterotomy, pancreatic sphincter precutting has a significantly higher rate of bile duct cannulation and a lower morbidity. So pancreatic sphincter precutting is an effective and safe technique for patients in whom selective cannulation of the common bile duct has failed.