| 谢娟，李国庆，陈宏辉，钟大志，雷国英，周晶.十二指肠乳头针形刀开窗术和辅助法在困难性ERCP中的应用.[J].中南医学科学杂志.,2011,39(5):552-555. |
| 十二指肠乳头针形刀开窗术和辅助法在困难性ERCP中的应用 |
| Applications of Needle-knife Fistulotorny and Other Complementary Techniques on the Difficult ERCP |
| 投稿时间：2011-04-21 |
| DOI： |
| 中文关键词: 内镜逆行胰胆管造影术 开窗术 成功率 并发症 |
| 英文关键词:endoscopic retrograde cholangiopancreatography(ERCP) fistulation success rate complications |
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| 中文摘要: |
| 目的探讨困难性内镜下逆行性胰胆管造影（ERCP）的操作技巧。方法2005年1月～2010年3月,本院共行ERCP 556例，分别采用下列方法进行插管：（1）采用双腔乳头切开刀常规插管；（2）捻导丝辅助法；（3）预备性切开后插管；（4）十二指肠乳头针形刀开窗术。结果556例采用双腔乳头切开刀常规插管，成功467例，成功率84.0%；未成功89例采用捻导丝辅助法，成功33例，总成功率89.9%；余下56例采用预备性切开后插管36例，成功31例，总成功率95.5%；余25例未成功者采用十二指肠乳头针形刀开窗术14例，成功13例，总成功率97.8%。共12例未成功者，其中1例因担心大出血和十二指肠穿孔停止开窗术，采用外科手术治疗，余下11例因无预备性切开及开窗术指征，ERCP失败。与常规插管方法比较，十二指肠乳头针形刀开窗术和辅助法插管总成功率明显升高（P<0.05)。术后无穿孔及死亡病例，高淀粉酶血症、PEP等并发症在ERCP术后总的发生率与插管成功者比较，差异无显著性(P>0.05)。结论在困难性胆管插管的ERCP病例中，应用十二指肠乳头针形刀开窗术和辅助法可以有效提高ERCP诊治的成功率，而并不增加并发症的发生率和死亡率。 |
| 英文摘要: |
| ObjectiveTo approach the skill and value of difficult ERCP.MethodsFrom January 2005 through March 2010,we had performed 556 cases of ERCP,and have made the following methods for cannulation:（1）selective cannulation of the CBD in standard method;（2）wire-guiding introduction;（3）cannulation after precutting papillotomy;（4）cannulation after needle-knife fistulotorny.ResultsSelective cannulation of the CBD in standard method was immediately achieved in 467 of 556 patients (84.0%),and in the unsuccessfully 89 cases,cannulation by wire-guiding introduction was achieved in 33 of 89 patients and the total success rate was 89.9%.Thirty-six cases of the other 56 patients were made to cannulation after precutting papillotomy,and were achieved in 31 of 36 patients (95.5%).In the 25 cases of unsuccessful cannulation by the above methods,cannulation after needle-knife fistulotorny was achieved in 13 of 14 patients,and the total success rate was 97.8%.In the last 12 cases of unsuccessfully cannulation,one case stop needle-knife fistulotorny because of worrying bleeding and perforation,and the other 11 cases have no indication for precutting papillotomy,so ERCP was unsuccessful.Applications of needle-knife fistulotorny and other complementary techniques could increase the total success rate of ERCP vs.standard method，with a statistically significant difference (P<0.05).There was no perforation and deaths.Compared with all patients of ERCP，the incidences of hyperamylasemia and PEP in the successful intubation patients had no statistically significant difference (P>0.05).ConclusionsApplications of needle-knife fistulotorny and other complementary techniques could obtain success in majority of the difficult ERCP,and there was no increase of severe complications and mortality. |
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