Vater乳头新分型应用于ERCP针刀瘘管切开术的研究进展

经内镜逆行胰胆管造影术(Endoscopic Retrograde Cholangiopancretography, ERCP)的成功有赖于选择性胆管插管(Selective Biliary Cannulation, SBC),而SBC是ERCP最重要的步骤。然而,进入胆道系统的传统技术可能在5%~35%的病例中失败。因此,在接受ERCP的患者中,需要更先进的插管技术。

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

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。

经胰管括约肌切开与针刀切开胆总管219例

目的:通过对比胰管括约肌切开和针刀切开的成功率和并发症发生率,探讨胰管括约肌切开获得胆总管通道的可行性和安全性。方法:对219例选择性胆总管插管失败的病人分别施行针刀切开(NK组n=113)或经胰管括约肌切开(PSP组n=106),分别统计两组切开方法的成功率和并发症发生率。结果:219例中有209例十二指肠乳头括约肌切开成功(95.4%),PSP组成功插管104/106例(98.1%),NK组成功插管105/113例(92.9%)。结论:同针刀切开相比,胰管括约肌切开术有较高的成功率和较低的并发症率,是一项安全、有效的预切开方法。

经内镜针刀括约肌切开术的临床应用

目的：探讨经内镜针刀括约肌切开术在临床中的应用价值。方法；对常规捕管失败的ERCP患者,进行针刀乳头前切开术和针刀开窗术治疗.结果：针刀乳头前切开术29例，针刀开窗术56例中，行ERCP成功81例（95．29％），并发症6例（7．06％），其中乳头部山101．3例（3．53％），胆管炎1例（1．18％），急性水肿性胰腺炎2例（2．44％），均经保守治疗后缓解。本组无穿孔和死亡并发症。结论：经内镜针刀括约肌切开术是一种安全、有效的非捕管乳头括约肌切开的方法．可作为常规ERCP和EST的重要补充手段，提高ERCP诊治的成功率。

416例次针形刀困难乳头括约肌切开的体会

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222例采用针形刀开窗术(needle-knife fenestration,NKF),158例直接用针形刀做乳头切开(needle-knife papillotomy,NKP),36例NKF失败后再行NKP。结果NKF组成功率75.2%(167/222),NKP组97.9%(190/194),总成功率85.8%(357/416)。术后发生胆道感染5例(1.2%),其中3例转外科手术胆道引流,2例重新经内镜置入引流管和用抗生素控制感染。术后并发胰腺炎24例(5.8%),其中1例急性重症胰腺炎经3处腹腔穿刺引流术治愈,余均经内科保守治疗。切口大量出血1例,内镜下注射硬化剂止血。结论应用针形刀可使极大多数标准EST或预切开失败者获得乳头切开成功。NKP成功率明显高于NKF,重新NKP可再提高成功率,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长者应尽量限制。

CLINICAL OBSERVATION ON TREATMENT OF ANAL FISSURE BY APPLYING SPHINCTEROTOMY WITH ACUPOTOM

Objective: To observe the therapeutic effect and features of acupotomy in the treatment of anal fissure. Methods: Seventy-six cases with anal fissure were randomly divided into two groups, namely, acupotomy group in which 37 patients were treated by anal internal sphincterotomy with acupotomy, and conventional anal sphincterotomy group (conventional group, n=39) that was treated by conventional amputation of the anal sphincter. Results: After treatment, twenty-six over 37 cases in acupotomy group recovered completely and the other 9 cases were improved clinically, with the total effective rate being 94.59%. In conventional group, 27 over 39 cases recovered completely and the other 11 cases were improved clinically. The total effective rate was 97.44%. There was no significant difference in the curative rate between two groups. However, compared with those of conventional group, patients in acupotomy group had significantly less bleeding, earlier healing of fissure and less pain. Conclusion: The results suggest that acupotomy treatment of anal fissure with anal sphincterotomy is a better therapeutic technique with advantages of easier manipulation, earlier healing and milder wound, less infectious complications and pain.