经胰管预切开在内镜逆行胰胆管造影困难插管中的应用

Application of transpancreatic duct precut technique in difficult bile duct canulation

目的探讨经胰管预切开对提高经内镜逆行胰胆管造影(ERCP)中胆道插管成功率的作用及安全性。方法回顾性分析46例经胰管预切开后再行治疗性ERCP的病例资料。结果 46例需选择性胆管插管的ERCP患者,经常规胆管插管失败,经胰管预切开后42例胆管插管成功(成功率91.3%),术后胰腺炎2例(发生率4.3%),无上消化道出血、穿孔及死亡病例,均保守治愈。结论在常规插管困难且导丝能进胰管时,应考虑行胰管预切开术,能提高选择性胆管插管成功率。经胰管预切开术是选择性胆管困难插管的一种有效、安全的措施,经胰管预切开术不会增加ERCP术后胰腺炎的风险。

Objective To investigate the effect of transpancreatic duct precut technique on the success rate and safety of difficult bile duct canulation in endoscopic retrograde cholangiopancreatography（ERCP）. Methods Retrospective analysis was made in46 cases of difficult bile duct canulation undergoing transpancreatic duct precut surgery. Results Forty-six ERCP patients who required selective bile duct canulation failed in routine bile duct canulation,but following transpancreatic duct precut,42 cases succeeded in canulation,with a success rate of 91. 3%. There were only 2 cases of postoperative pancreatitis（with an incidence of 4. 3%）,but without digestive tract hemorrhage,perforation and death and were all cured with conservative treatment. Conclusion Transpancreatic duct precut technique is an effective and safe treatment method in case of difficult biliary canulation and will not increase the risk of pancreatitis in the patients following ERCP surgery.