经内镜乳头括约肌切开困难原因分析

DIFFICULT ENDOSCOPIC SPHINCTEROTOMY: ANALYSIS OF THE CAUSES

为提高对经内镜乳头括约肌切开术（ＥＳＴ）切开困难患者的治疗水平，总结了２２１例困难ＥＳＴ患者的资料。困难的原因１８７例为乳头良性狭窄，壶腹部结石嵌顿或解剖异常，致切开刀未能插入足够的深度；３４例为乳头开口过厚或焦痂形成无法继续切开。改用自制小切开刀和针型切开刀进行治疗，效果满意。认为凡乳头不能满意插入切开刀者，应先改用短小的切开刀作逐段切开，焦痂形成者宜先用针型切开刀切开焦痂，而后再用弓型切开刀向上切开。确难以从乳头开口切开者，则改用针型切开刀作乳头开窗并扩大切开。

The materials of endoscopic sphincterotomy (EST) in 221 cases with difficulty in manipulation were reviewed to upgrade EST therapeutic efficacy. The difficulties rose from: (1) benign stenosis of ampulla Vater, incarcerated stones or anatomical deformities (n=187) resulting in insufficient insertion of sphincterotome; (2) incision being impeded by severe hypertrophy or eschar formation at the orifice (n=34). Using selfdesigned knifes satisfactory results were obtained to deal with these obstacles. It is experienced that with insufficieut insertion of standard knife, the shortknife is indicated to make stepwise small precuts; the needleknife is good for eschars followed by the bowknife, for that incapable of incising by way of the orifice, needleknife can be applied at the ampulla above the orifice to open one or two “windows”, through which the opening is extended.