中华消化内镜杂志
中華消化內鏡雜誌
중화소화내경잡지
CHINESE JOURNAL OF DIGESTIVE ENDOSCOPY
2010年
9期
454-457
,共4页
周玉保%黄慧%潘亚敏%王田田%王书智%陆蕊%王淑萍%时之梅%孙志飞%胡冰
週玉保%黃慧%潘亞敏%王田田%王書智%陸蕊%王淑萍%時之梅%孫誌飛%鬍冰
주옥보%황혜%반아민%왕전전%왕서지%륙예%왕숙평%시지매%손지비%호빙
胰胆管造影术,内窥镜逆行%主乳头%开窗术%成功率%并发症
胰膽管造影術,內窺鏡逆行%主乳頭%開窗術%成功率%併髮癥
이담관조영술,내규경역행%주유두%개창술%성공솔%병발증
Cholangiopancreatography,endoscopic retrograde%Major papilla%Fistulation%Success rate%Complications
目的 探讨采用针状刀实施十二指肠乳头开窗术,在ERCP困难胆管插管中的应用价值及其安全性.方法 回顾性分析近年来接受ERCP治疗的患者中,当常规插管方法和(或)其他预切开技术无法进入胆管时,采用针状刀在主乳头背部选点进行电灼造口,完成胆管深插管及后续治疗.观察本方法的成功率和术后并发症,并对相关影响因素进行分析.结果 共有108例患者接受开窗术,其中97例(91.2%)成功插至胆管;11例胆管恶性梗阻患者虽经开窗仍无法进入胆管,其中远端恶性梗阻失败率(25.8%,8/31),明显高于近端梗阻(5.3%,3/57),(P=0.014,χ2=5.983).ERCP术后发生胰腺炎5例(4.6%),其中插管失败组(18.2%,2/11)明显高于成功组(3.1%,3/97)(P=0.006,χ2=7.418);另有肠道穿孔1例、胆管炎4例,均经保守治疗控制.结论 在困难胆管插管的ERCP病例中,应用针状刀行乳头开窗术可以有效提高ERCP诊治的成功率,对于有经验的操作者该方法是较为安全的;但远端胆管恶性梗阻行乳头开窗术的成功率较低.
目的 探討採用針狀刀實施十二指腸乳頭開窗術,在ERCP睏難膽管插管中的應用價值及其安全性.方法 迴顧性分析近年來接受ERCP治療的患者中,噹常規插管方法和(或)其他預切開技術無法進入膽管時,採用針狀刀在主乳頭揹部選點進行電灼造口,完成膽管深插管及後續治療.觀察本方法的成功率和術後併髮癥,併對相關影響因素進行分析.結果 共有108例患者接受開窗術,其中97例(91.2%)成功插至膽管;11例膽管噁性梗阻患者雖經開窗仍無法進入膽管,其中遠耑噁性梗阻失敗率(25.8%,8/31),明顯高于近耑梗阻(5.3%,3/57),(P=0.014,χ2=5.983).ERCP術後髮生胰腺炎5例(4.6%),其中插管失敗組(18.2%,2/11)明顯高于成功組(3.1%,3/97)(P=0.006,χ2=7.418);另有腸道穿孔1例、膽管炎4例,均經保守治療控製.結論 在睏難膽管插管的ERCP病例中,應用針狀刀行乳頭開窗術可以有效提高ERCP診治的成功率,對于有經驗的操作者該方法是較為安全的;但遠耑膽管噁性梗阻行乳頭開窗術的成功率較低.
목적 탐토채용침상도실시십이지장유두개창술,재ERCP곤난담관삽관중적응용개치급기안전성.방법 회고성분석근년래접수ERCP치료적환자중,당상규삽관방법화(혹)기타예절개기술무법진입담관시,채용침상도재주유두배부선점진행전작조구,완성담관심삽관급후속치료.관찰본방법적성공솔화술후병발증,병대상관영향인소진행분석.결과 공유108례환자접수개창술,기중97례(91.2%)성공삽지담관;11례담관악성경조환자수경개창잉무법진입담관,기중원단악성경조실패솔(25.8%,8/31),명현고우근단경조(5.3%,3/57),(P=0.014,χ2=5.983).ERCP술후발생이선염5례(4.6%),기중삽관실패조(18.2%,2/11)명현고우성공조(3.1%,3/97)(P=0.006,χ2=7.418);령유장도천공1례、담관염4례,균경보수치료공제.결론 재곤난담관삽관적ERCP병례중,응용침상도행유두개창술가이유효제고ERCP진치적성공솔,대우유경험적조작자해방법시교위안전적;단원단담관악성경조행유두개창술적성공솔교저.
Objective To evaluate the effectiveness and safety of needle-knife fistulotomy (NKF)for difficult cannulation during endoscopic retrograde cholangiopancreatography (ERCP). Methods Data of patients, who received NKF on the back of major papilla when bile duct could not be accessed by conventional cannulation and/or other pre-cut methods during ERCP, were retrospectively reviewed. The success rate of deep cannulation and its complications were observed and analyzed. Results NKF was performed in 108patients due to difficult cannulation, which succeeded in 97 (91.2%) in access to the bile duct and failed in 11 patients with malignant biliary strictures. The failure rate in patients with distal malignant obstruction was higher (25. 8%, 8/31) than those with proximal lesions (5.3%, 3/57) (P = 0. 014, χ2 = 5. 983).Post-ERCP pancreatitis occurred in 5 cases (4. 6%), with the incidence significantly higher in NKF-failure group (18. 2%, 2/11) than that in NKF-suocess group (3.1% ,3/97) (P = 0. 006, χ2 = 7.418). Intestinal perforation occurred in 1 patient and cholangitis developed in 4 others, which all recovered after conservative managements. Conclusion NKF for difficult cannulations in ERCP is safe and effective, especially in hands of experienced operators, but cannulation success rate is relatively low in distal malignant biliary obstruction.
