Precut技术在ERCP插管困难病例中的作用及安全性研究--《中国消化内镜》

Precut技术在ERCP插管困难病例中的作用及安全性研究

 

 李初俊，崔毅，黄颖思，陈?湖

 

【摘要】

目的  探讨Precut技术在ERCP插管困难病例中的作用及其安全性。

方法  回顾性分析1997年9月至2007年12月间进行ERCP诊断与治疗操作中常规插管，包括导丝辅助均无法插入胆管且实施了Precut操作的病例。Precut实施采用的是弓形刀和/或针状刀，Precut方法包括经乳头弓形刀乳头括约肌预切开术、经胰管弓形刀乳头括约肌预切开术、针状刀乳头括约肌预切开术和针状刀乳头括约肌开窗术。所有行Precut后能成功深插管的病例如有必要则改用常规方法将十二指肠乳头开口扩大至理想的大小。中山大学附属第六医院消化内镜中心李初俊

结果  共有65例因ERCP插管困难而实施了Precut操作，年龄19~78岁，平均53岁。总的成功率为83.1%(54/65)。术后高淀粉酶血症的发生率为46.2%(30/65)，轻症急性胰腺炎发生率为3.1%(2/65)，经治疗3～5天后均能恢复至正常。未出现术后出血与穿孔并发症。

结论  Precut技术是ERCP插管困难病例达到插管成功的有效、安全的办法，可由资深的消化内镜医生应用于确实有需要进行治疗性ERCP的病例。

【关键词】  precut技术；预切开术；开窗术；ERCP/治疗

 

The Efficacy and Safety of Precut Technique in difficult biliary cannulation 

LI Chu-jun, CUI Yi, HUANG Ying-si, CHEN Min-hu

 

【Abstract】

Objective  To evaluate the efficacy and safety of the precutting techniques for difficult CBD cannulation.

Methods  Retrospective study the precutting cases due to difficult cannulation from September 1997 to December 2007. All the cases couldn’t achieve deep CBD cannulation although guidewire cannulation technique is used. The precutting techniques include precut papillotomy, transpancreatic precut sphincterotomy, needle-knife precut sphincterotomy and needle-knife fistulotomy. The standard endoscopic sphincterotomy would be performed after precut procedure if needed.

Results  A total of 65 patients (39 male, 26 female; 19-78  years, 53 years for mean) with difficult CBD cannulation underwent precutting technique. The procedure was successful in 54 of the patients (83.1%, 54/65). The complications after precut procedure were hyperamylasemia (46.2%, 30/65), mild acute pancreatitis (3.1%, 2/65). No bleeding and perforation occurred after precut procedure in this study.

Conclusions  Precut is an effective and safe technique in difficult biliary cannulation. It can be used in experienced hands when clinically indicated on therapeutic ERCP.

  【Key word】 precut technique; precut sphincterotomy; fistulotomy; ERCP/therapeutic

 

参考文献

 

1.     Artifon EL, Sakai P, Cunha JE. et al. Guidewire cannulation reduces risk of post-ERCP pancreatitis and facilitates bile duct cannulation. Am J Gastroenterol, 2007, 102(10):2147-2153.

2.      Catalano MF, Linder JD, Geenen JE. Endoscopic transpancreatic papillary septotomy for inaccessible obstructed bile ducts: Comparison with standard pre-ctu papillotomy. Gastrointest Endosc, 2004, 60(4): 557-561.

3.      Goff JS. Long-term experience with the transpancreatic sphinter pre-ctu approach to biliary sphincterotomy. Gastrointest Endosc, 1999, 50(5):642-645.

4.      Mavrogiannis C, Liatsos C, RomanosA, et al. Needle-knife fistulotomy versus needle-knife precut papillotomy for the treatment of common bile duct stones. Gastrointest Endosc, 1999, 50(3):334-339.

5.      de Weerth A, Seitz U, Zhong Y, et al. Primary precutting versus conventional over-the-wire sphincterotomy for bile duct access: a prospective randomized study. Endoscopy, 2006, 38(12): 1235-40.

6.       Varadarajulu S, Palaniswamy KR. Precut papillotomy is effective and safe only “when” clinically indicated and “in” expert hands. J Clin Gastroenterol, 2007,41(5):528-533.

 

---《中国消化内镜》2008.3;2(3):19-23