针形刀困难乳头切开术253例

Needle-knife fistulotomy for 253 Cases of difficult papillotomy

目的:探讨针形切开刀在困难乳头括约肌切开术中应用的技巧和价值.方法:本组182例采用针形刀开窗术(NKF),71例直接用针形切开刀作乳头切开(NKP).结果:NKF组的成功率为94.5%,NKP组全部成功,总成功率为96.0%.4例术后发生胆道感染,其中2例转外科手术胆道引流.9例并发术后胰腺炎(均为水肿型).24例发生轻度切缘出血,经局部喷洒孟氏液后止血.2例因导丝错位而穿孔,但未造成后腹膜腔感染.结论:针形切开刀的应用可使大多数困难的标准EST或前切开失败者获得乳头切开成功,而严重的并发症和死亡率并无增加,但对乳头过小和胆总管末端较细者应尽量限制.

AIM:To approach to skill and value of application of needle -knife in difficult papillotomy. METHODS:Needle-knife fistulotomy(NKF) was put up in 182 cases and papillotomy directly with needle-knife in 71 cases. RESULTS:Successful rate of NKP group was 94.5%,needle-knife pap illotomy(NKP) group was 100% and total successful rate was 96.0%.4 cases had bil iary tract infection,of them,2 cases were transferred to surgical ward for billi ary tract draining through operation.9 cases concured with post-operative pancr eatitis(all was edema type).24 cases had slight bleeding on the incisal edge,ble eding stopping after insufflation of local Meng’s fluid. 2 cases had perforatio n because of guide filaments malposition,but no infection on post-peritoneum. CONCLUSION:Needle-knife could obtain success of papillotomy fo rfailure of main difflication standard EST or precut papillotomy and there was no increase of severe complications and mortality but should give limitation as possible to smaller papilla and finer end of choledochus.