经胰管乳头括约肌预切开术在困难胆道插管中的临床应用  

Clinical application of transpancreatic sphincterotomy for inaccessible common bile duct

作　　者：刘枫[1] 李兆申[1] 时昭红[1] 邹多武[1] 金震东[1] 邹晓平[1] 孙振兴[1] 

机构地区：[1]第二军医大学附属长海医院消化内科,上海200433

出　　处：《中华消化内镜杂志》2007年第3期177-179,共3页Chinese Journal of Digestive Endoscopy

摘　　要：目的评价经胰管乳头括约肌预切开术在困难胆道插管中的安全性和疗效。方法回顾性分析2005年7月至2006年7月在我院行 ERCP 的患者。对常规胆管插管失败且导丝反复进入胰管(>4次)者行经胰管乳头括约肌预切开,胆管插管成功后,导丝留置胆管内,继续完成胆管括约肌切开及相应的治疗。统计插管的成功率及并发症的发生率。结果在整个研究期间内共行 ER-CP 1576例次,需胆管深插管879例次,经胰管乳头括约肌预切开者30例。经胰管乳头括约肌预切开后,首次 ERCP 胆管深插管成功率为93.3%(28/30),2次 ERCP 插管成功率为96.7%(29/30)。2例(占6.7%)发生并发症,为轻型胰腺炎。无出血、穿孔或操作相关的死亡发生。结论在困难胆道插管中采用经胰管乳头括约肌预切开术是一种安全有效的方法。Objective The aim of this study was to assess the success and the complication rates of transpancreatic sphincterotomy in achieving cannulation of an inaccessible bile duct. Methods A retrospective study of all consecutive ERCPs performed at our institution from July 1,2005 to July,2006 was analyzed to identify all cases in which transpancreatic sphincterotomy was performed . This less well-described pre-cut technique involves initial cannulation of the pancreatic duct with a ＂traction-type＂ papillotome with pancreatic giude-wire placement and then incision toward the bile duct. It was reviewed to assess cannulation success and complications. Results 1576 ERCPs performed in the period, Of which deep cannulation of bile duct was performed in 879 cases. 30 had a transpancreatic pre-cut sphincterotomy. Successful cannulation of the bile duct was achieved in 28 of the 30 patients （93.3%） in initial ERCP. Successful rate of cannulation of the bile duct was 96. 7% in second ERCP. ERCP post-pancreatitis occurred in two patients and was mild. There were no hemorrhage, perforation and procedure-related deaths. Conclusion In case of difficult common bile duct cannulation, transpancreatic sphincterotomy appears to be an effective and safe technique.

关 键 词：奥狄括约肌 胰胆管造影术 内窥镜逆行 胰腺炎 

分 类 号：R657.4[医药卫生—外科学]