针状切开刀在治疗性ERCP插管困难病例中的应用

Application and research of the needle knife in the therapeutic endoscopic retrograde cholangiopancre- atography with difficult biliary duct cannulation

目的探讨用针状切开刀为主的乳头括约肌预切开术（PST）在治疗性逆行胰胆管造影术（ERCP）插管困难病例中的应用，并对其在治疗性ERCP中的作用和安全性作回顾性评价。方法954例常规ERCP病例中，70例患者在实施ERCP治疗操作中，当常规方法不能使胆系显影或胆道深部插管困难时，即用标准切开刀（经胰管）和针状切开刀行乳头预切开，观察预切开的效果和近期并发症。结果常规ERCP诊治成功884例92．6％，失败70例中用各种针状预切开术，成功率达88．5％，使用各种针状预切开术后使ERCP成功率提升6．6个百分点，使成功率由92．6％提升达到99．2％。两者差别显著（P〈0．001）。常规ERCP的并发症为8．69％，无内镜相关死亡。新式预切开术组并发症为10％，且与常规ERCP组相比并发症无差异。（P〉0．05）。结论本文介绍的针状切为主的乳头括约肌预切开术及粘膜桥切断技术和开口上移技术在治疗性ERCP遇到深插管困难情况下是一种行之有效的操作技术，可明显提高成功率，且并发症少。

Objective With the needle knife or a plough-like pull-type sphincterotome for precuting, to retrospectively evaluate the efficacy and safety of the e precut sphincterotomy technique during the therapeutic endoscopic retrograde cholangiopancreatography （TERCP） with difficult biliary duct cannulation （ DBDC ）. Methods With needle knife or a plough-like pull-type sphincterotome （underwent pancreatic duct） , the preeut were cgrried out in 70 patients of 954 patients when conventional method was not able to visualize the biliary tract or deep cannulation provesd difficult during ERCP. The follow-up concentrated on the efficacy of precut and shortterm complication and compared with conditional EST. Results （1）The totle 960 patients accepted ERCP, 92. 6% patients acquired successful cannulation in conventional ERCP. 88.5% patients were obtained succeed for deep cannulation in failed 70 patients by carrying out precut technique. Success rate of bile duct deep eannu- lation was promoted 6. 6 percent point for carrying out precut technique. Success rate of bile duet deep eannulation achieved 99.2% above of 92. 6% in conventional ERCP, and difference was significant（ P 〈 0. 001 ） ;（2）the complications of conventional ERCP occurd in 8. 69% and the complications of precut technique group was 10% ;The complications among theprecut technique group were not different from conventional ERCP （ P 〉 0. 05 ）. Conclusion The precut methods include mucosal bridge precut （ Deng＇ s preeut） and up-removal orifice technique （UROT） with the needle knife or a plough-like pull-type sphincterotome are highly effective methods to gain biliary access during TERCP with DBDC. It can promote the rate of succeed in deep cannulation with fewer complications.