CAJ | 학술논문

目的探讨内镜下十二指肠乳头预切术在恶性胆道梗阻诊治中的应用价值.方法对46例插管困难的恶性胆道梗阻患者,根据十二指肠乳头及其周围结构、插管情况等采用不同预切方法对乳头括约肌施行内镜下预切术,观察ERCP诊治的完成情况,以及并发症发生情况.结果应用弓形刀切开法4例、针状刀切开法24例、经胰管胆管切开法12例、联合方法6例,其中35例预切术后胆管插管成功,成功率达76.1%(35/46).发生术后黏膜渗血3例、胰腺炎1例、高淀粉酶血症2例、胆管炎1例,未见穿孔发生.结论内镜下乳头预切术可提高恶性胆道梗阻患者ERCP诊治的成功率,且适时、正确地应用可以降低并发症的发生率.
목적 탐토내경하십이지장유두예절술재악성담도경조진치중적응용개치.방법 대46례삽관곤난적악성담도경조환자,근거십이지장유두급기주위결구、삽관정황등채용불동예절방법대유두괄약기시행내경하예절술,관찰ERCP진치적완성정황,이급병발증발생정황.결과 응용궁형도절개법4례、침상도절개법24례、경이관담관절개법12례、연합방법6례,기중35례예절술후담관삽관성공,성공솔체76.1%(35/46).발생술후점막삼혈3례、이선염1례、고정분매혈증2례、담관염1례,미견천공발생.결론 내경하유두예절술가제고악성담도경조환자ERCP진치적성공솔,차괄시、정학지응용가이강저병발증적발생솔.
Objective To evaluate the endoscopic precut sphincterotomy for malignant biliary obstruction. Methods Endoscopic precut sphincterotomy was performed in different ways for 46 patients with malignant biliary obstruction and difficult biliary cannulation according to the anatomic structure of the papilla and cannulation. Ways of precut were summarized and complications were analyzed. Results Precut sphincterotomy was performed with bow-like knife in 4 patients, with needle-knife in 24, with trans-pancreatic sphincterotomy in 12 and with combined ways in 6. The procedure succeeded in 35 cases (76. 1%, 35/46). Post-procedure complications included bleeding in 3 patients, pancreatitis in 1, hyper-amylasemia in 2and cholangitis in 1. No perforation was found. Conclusion Endoscopic precut sphincterotomy is not only able to improve the therapeutic endoscopy achievement rate in patients with malignant biliary obstruction, but also to lower the incidence of complications if used adequately.