经内镜针刀括约肌切开术治疗壶腹部梗阻性疾病的应用价值

THE VALUE OF ENDOSCOPIC NEEDLE-KNIFE PRECUT SPHINCTEROTOMY (PST) IN AMPULLA OBSTRUCTION

探讨经内镜针状刀乳头括约肌切开术 (PST)治疗壶腹部梗阻性疾病的临床应用价值。方法 :对乳头结石嵌顿、壶腹部良恶性狭窄的肿大乳头作常规ERCP乳头插管失败后 ,进行针刀电切 ,找到胆总管下端开口 ,行ERCP成功后改用常规电刀切开或乳头气囊扩张 ,再行网篮取石、置管引流或乳头活检等。结果 :5 1例PST后 ,行ERCP成功 4 4例 (86 .3% ) ,未成功 7例 (13.7% ) ;其中 16例乳头嵌顿性结石全部排出 ;13例狭窄性乳头炎伴胆总管结石 ,10例取石成功 ;12例单纯性乳头良性狭窄 ,10例狭窄治疗成功 ;10例壶腹部恶性肿瘤 ,8例内镜诊治成功。出现并发症 6例 (11.8% ) ,乳头出血 3例、胆管炎 1例、水肿性胰腺炎 2例 ,均经保守治疗后缓解。结论 :乳头结石嵌顿、壶腹部良恶性狭窄 ,在常规内镜乳头插管困难时 ,采用PST技术 ,患者可以得到有效的内镜诊断和诊疗 ,是常规ERCP和EST的重要补充手段。

Objective:To disscuss the clinical value of PST in treatment of ampulla obstruction.Methods:In patients in whom deep cannulation proves difficult(benign or malignant ampulla constriction), we use PST to find the opening of common bile duct before regular ERCP.Results:There are 51 PST patients, after which the successful rate of ERCP is 86.3%(44/51), including: 16 patients in whom stone is wedged in papilloma(stones are taken out in all paitents), 13 constrictive papillitis with stone in common bile duct(10/13 are taken the stone out successfully), 12 benign constriction of papilloma(10/12 can be taken EST after PST). 10 malignant ampulla constriction,8 of them were treated successfully. Complications are found in 6 patients. (6/51, 11.8%): 3 mild papilla haemorrhoid, 1 cholangitis, 2 acute mild pancreastitis. There are no PST related mortality in all 51 patients.Conclusions:In patients who have stone wedged in papilloma and benign or malignant papilla constriction, PST can be a safe and effective methods to help cannulation or EST.