经胰管预切开联合针形刀技术对困难胆管插管治疗的研究  

Study on Treatment of Difficult Cannulation Through Transpancreatic Precut Sphincterotomy Combined With Needleknife Fistulotomy

作　　者：刘文辉 邵东[1] 杨璟[1] 庄耘[1] 徐馥[1] 陈建平[1] LIU Wenhui;SHAO Dong;YANG Jing;ZHUANG Yun;XU Fu;CHEN Jianping(Department of Gastroenterology,Changzhou First People＇s Hospital,Changzhou Jiangsu 213000,China)

机构地区：[1]常州市第一人民医院消化内科,江苏常州213000

出　　处：《中国继续医学教育》2018年第33期97-99,共3页China Continuing Medical Education

摘　　要：目的观察经胰管预切开联合针形刀技术对困难胆管插管经内镜逆行性胰胆管造影术(endoscopic retrograde cholangiography,ERCP)的效果及相关并发症。方法选取插管失败且胰管导丝占据法、胰管支架占据法、经胰管预切开术等方法仍失败的困难插管患者56例作为研究对象。所有患者均行经胰管预切开联合针形刀术。观察患者的成功率及并发症。结果入选患者行胰管弓形刀预切开联合针形刀预切开均插管成功,术中出血发生率8.9%,术后胰腺炎发生率5.4%,术后高淀粉酶血症发生率7.1%。结论对于胆管插管困难的患者,可行经胰管弓形刀预切开联合针形刀预切开术,且有较好的可靠性及安全性。Objective To observe the effect and complications of endoscopic retro grade cholangiopancreatography （ERCP） for difficult bile duct cannulation through transpancreatic precut sphincterotomy combined with needle-knife fistulotomy. Methods 56 cases of patients with diffcult cannulation who failed in methods, such as pancreatic duct guide wire occupying method, pancreatic duct stent occupying method, transpancreatic precut sphincterotomy and so on were selected as the study objects, all patients underwent transpancreatic precut sphincterotomy combined with needle-knife fistulotomy, and the success rate and complications were observed. Results All patients were successfully treated with transpancreatic precut sphincterotomy combined with needle-knife fistulotomy. The incidence of bleeding during operation was 8.9%, the incidence of postoperative pancreatitis was 5.4%, and the incidence of postoperative hyperamylasemia was 7.1%. Conclusion Transpancreatic precut sphincterotomy combined with needle-knife fstulotomy is feasible for patients with diffcult cannulation ,and has good reliability and safety.

关 键 词：困难插管 ERCP 经胰管预切开 针形刀 十二指肠乳头 胰腺炎 高淀粉酶血症 

分 类 号：R575[医药卫生—消化系统]