经胰管弓状刀乳头括约肌预切开术在ERCP困难性胆管插管患者的应用

Application of transpancreatic duct papillotomy by arcuate knife precut for difficult cannulation of common bile duct in ERCP

目的总结经胰管弓状刀乳头括约肌预切开术在内镜逆行胰胆管造影术(ERCP)困难性胆管插管的应用效果。方法因胆管插管困难行乳头括约肌预切开术患者187例中,114例患者采用经胰管弓状刀(A组),73例采用针状刀(B组),比较两组手术成功率与并发症。结果 A、B组插管成功率相仿(93.9%vs.91.8%)(P>0.05)。A组胰腺炎和出血发生率为5.3%和3.5%,低于B组的15.1%和12.3%(P<0.05)。两组胆管炎发生率相仿(4.4%vs.5.5%)(P>0.05),均无穿孔及死亡病例。结论经胰管弓状刀或针状刀乳头括约肌预切开术均能有效提高困难性ERCP胆管插管的成功率;前者胰腺炎和出血发生率较低。

Objective To summarize the outcomes of transpancreatic duct papillotomy by arcuate knife precut for difficult cannulation of common bile duct in endoscopic retrograde cholangiopancreatography（ERCP）.Methods Of 187 patients with difficult cannulation of common bile duct in ERCP,sphincterotomy was performed with arcuate knife（group A,114cases）or needle knife（group B,73cases）.The success rate and complications were compared between two groups.Results The success rate of biliary cannulation of group A was similar to that of group B（93.9% vs.91.8%）（P〈0.05）.The incidence rates of pancreatitis and bleeding after ERCP were lower in group A than those in group B（5.3% vs.15.1% and 3.5% vs.12.3%）（P〈0.05）.The incidence rate of cholangeitis after ERCP in group A was similar to that in group B（4.4% vs.5.5%）（P〈0.05）.There was no perforation or death in two groups.Conclusion The success rate of cannulation of biliary duct can be effectively improved by arcuate knife or needle knife precut of sphincterotomy in the patients undergoing ERCP.The formal has less complications of pancreatitis and bleeding after ERCP.