Precut技术对高龄乳头嵌顿性胆结石患者的疗效及安全性研究

The Efficacy and Safety of Precut Technique in Elderly patients of incarcerated biliary calculi in papilla

目的探讨Precut技术对高龄乳头嵌顿性胆结石患者的治疗效果及安全性的研究。方法总结回顾分析2007年1月至2009年12月38例高龄患者ERCP术后确诊乳头嵌顿性胆总管结石的患者，对经内镜逆行胰胆管造影术（ERCP）治疗中插管困难者运用Precut技术辅助插管及取石，行乳头括约肌切开后，结石常能自行脱出。结果38例高龄ERCP插管困难患者，行Precut技术取石成功率100％，无死亡病例，其中弓形刀切开8例，针状刀切开10例，两刀联合切开20例。结论治疗性ERCP是乳头嵌顿性胆结石患者一种安全有效的治疗手段，尤其对高龄无法耐受外科手术的患者，这类患者常伴插管及取石困难，Precut技术无疑是取石成功的关键。

Objective To evaluate the efficacy and safety of the Precut technique in elderly patients of incarcerated biliary calculi in papilla. Methods Retrospectived the study of the 38 elderly patients who finally diagnosed as incarcerated biliany calculi by the endoscopic retrograde cholangio pancreatography（ERCP） from January 2007 to December 2009. All patients with difficult CBD cannulation underwent Precutting technique. In most of patients the incarcerated biliary calculi in papilla could usually fell away automatically after EST. Resuits The 38 Elderly patients with difficult CBD cannulation underwent Precutting technique. The success rate of endoscopic stone extraction was 100% , and the mortality and morbidity were zero. Eight cases were performed with arciform knife, 10 cases were with needle knife, and 20 cases with both arciform and needle knife. Conclu- sion Precut is an effective and safe technique for patients in difficult biliary cannulation with incarcerated biliary calculi in papilla. Precut technique is the most important skill for endoscopic stone extraction.