乳头预切开术在内窥镜逆行胰胆管造影术中的应用

Application of precut sphinctero tomy in the diagnostic and therapeutic ERCP a report of 73 cases

目的 对乳头括约肌预切开术在内窥镜逆行胰胆管造影术（ＥＲＣＰ） 诊断和治疗中的作用及其安全性作回顾性评价．方法 ７３ 例患者在行ＥＲＣＰ 诊疗时，当常规操作不能使胆系显影或胆道深部插管困难时，即用犁状拉式刀行乳头预切开，观察预切开的效果和近期并发症．结果 全组胆道造影成功率９５－９ ％ ， 胆管深部插管成功率７２－９ ％ ，其中第一次操作胆道显影率９３－２ ％ ， 深部插管率６２－９ ％ ． 术后并发症５ 例（６－８ ％ ） ，包括轻度胰腺炎２ 例，发热３ 例．结论 乳头括约肌预切开术是ＥＲＣＰ 诊疗中成功进入胆道的一项极有效的方法，但需熟练的内镜医师操作． 采用犁状刀进行预切开安全性高，并发症少．

AIM To retrospectively evaluate the efficacy and safety of the precut sphincterotomy (PST) during diagnostic & therapeutic ERCP. METHODS With a plough like pull type sphincterotome, immediate PST was carried out in 73 patients recently when conventional method is not able to visualize the biliary tract or deep cannulation proves difficult during ERCP. The follow up concentrated on the efficacy of the procedure and short term complication. RESULTS The total success rate of bile duct visualization was achieved in 95 9% and deep cannulation in 72 9%. The success rates of the first time procedure were 93 2% and 62 9%, respectively. The complications of PST occur in 6 8% of patients, including mild pancreatitis in 2 patients and fever in 3. CONCLUSION Precut sphincterotomy is a highly effective method to gain biliary access during diagnostic and therapeutic ERCP, but should be carried out by experts only. With a plough like knife, PST seems more safe and carries fewer complications.