乳头括约肌预切开术在困难ERCP中的应用体会

The application experience of precut sphincterotomy in difficult ERCP

目的探讨乳头括约肌预切开术在困难ERCP中的应用价值。方法分析2007年7月至2008年12月331例行ERCP治疗的患者,其中42例常规方法选择性胆管插管困难者改行乳头括约肌预切开术治疗的临床资料,并进行比较。结果常规组:成功率85.2%,术后第3h和12h血清淀粉酶数值分别为(157±49)U/L和(241±37)U/L,术后高淀粉酶血症和急性胰腺炎发生率分别为37.0%和6.6%;PST组:成功率97.6%,术后第3h和12h血清淀粉酶数值分别为(164±52)U/L和(229±55)U/L,术后高淀粉酶血症和急性胰腺炎发生率分别为45.2%和7.1%。结论乳头括约肌预切开术安全、有效,可提高困难ERCP的成功率,但要严格掌握适应证,由经验丰富的医师进行。

Objective To evaluate the clinical value of precut sphincterotomy in difficult ERCP.Methods From July 2007 to December 2008,331 patients received routine ERCP in our hospital.42 cases of them were diverted to receive precut sphincterotomy,because selective bile duct cannulation with conventional methods was difficult.Both clinical data were studied and compared.Results Conventional group：the success rate was 85.2%,the measurement of serum amylase at 3 h and 12 h were 157±49 U/L and 241±37 U/L,the rates of postoperative hyperamylasemia and acute pancreatitis were 37.0% and 6.6%.PST group：the success rate was 97.6%,the measurement of serum amylase at 3 h and 12 h were 164±52 U/L and 229±55 U/L,the rates of postoperative hyperamylasemia and acute pancreatitis were 45.2% and 7.1%.Conclusion Precut sphincterotomy is a safe and effective technique and it could increase the success rate of difficult ERCP,but the indications should be grasped strictly and the performers should be experienced hands.