CAJ | 학술논문

目的探讨用针状切开刀为主的乳头括约肌预切开术(PST)在治疗性逆行胰胆管造影术(ERCP)插管困难病例中的应用,并对其在治疗性ERCP中的作用和安全性作回顾性评价.方法 954例常规ERCP病例中,70例患者在实施ERCP治疗操作中,当常规方法不能使胆系显影或胆道深部插管困难时,即用标准切开刀(经胰管)和针状切开刀行乳头预切开,观察预切开的效果和近期并发症.结果常规ERCP诊治成功884例92.6%,失败70例中用各种针状预切开术,成功率达88.5%,使用各种针状预切开术后使ERCP成功率提升6.6个百分点,使成功率由92.6%提升达到99.2%.两者差别显著(P<0.001).常规ERCP的并发症为8.69%,无内镜相关死亡.新式预切开术组并发症为10%,且与常规ERCP组相比并发症无差异.(P>0.05).结论本文介绍的针状切为主的乳头括约肌预切开术及粘膜桥切断技术和开口上移技术在治疗性ERCP遇到深插管困难情况下是一种行之有效的操作技术,可明显提高成功率,且并发症少.
목적 탐토용침상절개도위주적유두괄약기예절개술(PST)재치료성역행이담관조영술(ERCP)삽관곤난병례중적응용,병대기재치료성ERCP중적작용화안전성작회고성평개.방법 954례상규ERCP병례중,70례환자재실시ERCP치료조작중,당상규방법 불능사담계현영혹담도심부삽관곤난시,즉용표준절개도(경이관)화침상절개도행유두예절개,관찰예절개적효과화근기병발증.결과 상규ERCP진치성공884례92.6%,실패70례중용각충침상예절개술,성공솔체88.5%,사용각충침상예절개술후사ERCP성공솔제승6.6개백분점,사성공솔유92.6%제승체도99.2%.량자차별현저(P<0.001).상규ERCP적병발증위8.69%,무내경상관사망.신식예절개술조병발증위10%,차여상규ERCP조상비병발증무차이.(P>0.05).결론 본문개소적침상절위주적유두괄약기예절개술급점막교절단기술화개구상이기술재치료성ERCP우도심삽관곤난정황하시일충행지유효적조작기술,가명현제고성공솔,차병발증소.
Objective With the needle knife or a plough-like pull-type sphincterotome for precuting,to retrospectively evaluate the efficacy and safety of the e precut sphincterotomy technique during the therapeutic endoscopic retrograde cholangiopancreatography(TERCP)with difficult biliary duct cannulation(DBDC).Methods With needle knife or a plough-like pull-type sphincterotome(underwent pancreatic duct),the precut were carried out in 70 patients of 954 patients when conventional method was not able to visualize the biliary tract or deep cannulation provesd difficult during ERCP.Results ①The follow-up concentrated on the efficacy of precut and short 92.6% patients acquired successful cannulation in conventional ERCP.88.5% patients were obtained succeed for deep cannulation in failed 70 patients by carrying out precut technique.Success rate of bile duct deep cannulation was promoted 6.6 percent point for carrying out precut technique.Success rate of bile duct deep cannulation achieved 99.2% above of 92.6% in conventional ERCP,and difference was significang (P<0.001);②the complications of conventional ERCP occurd in 8.69% and the complications of precut technique group was 10%:The complications among theprecut technique group were not different from conventional ERCP(P>0.05).Conclusion The precut methods include mucosal bridge precut(Deng's precut)and up-removal orifice technique(UROT)with the needle knife or a plough-like pull-type sphincterotome are highly effective methods to gain biliary access during TERCP with DBDC.It can promote the rate of succeed in deep cannulation with fewer complications.