CAJ | 학술논문

目的：总结十二指肠乳头括约肌预切开术在困难插管的内镜逆行胰胆管造影术（ERCP）中的临床应用经验及技巧。方法回顾性分析我科自2010年1月-2013年12月间开展的对于 ERCP 插管困难的280例患者实施的十二指肠乳头括约肌预切开术，按照实施预切开术的先后，将280例患者分成 A、B 两组。A 组为2010年1月-2011年12月，实施预切开术初期的143例病例；B 组为2012年1月-2013年12月，汲取前一阶段经验教训，采取摆正乳头、看清轴向、短距离、分层、逐步、点切的方法进行的137例病例。比较两阶段预切开术后的插管成功率及并发症发生率，总结十二指肠乳头括约肌预切开术的操作经验及技巧。结果 A 组143例预切开术后插管成功113例，成功率79.02%，穿孔5例，发生率3.49%，出血4例，发生率2.80%，急性胰腺炎6例，发生率4.20%，无急性胆管炎及急性胆囊炎发生，总的并发症发生率10.49%。B 组137例预切开术后插管成功134例，成功率97.81%，穿孔1例，发生率0.73%，无消化道出血病例，急性胰腺炎3例，发生率2.19%，无急性胆管炎及急性胆囊炎发生，总的并发症发生率2.92%。A 组与 B 组比较，预切开术后插管成功率及总的并发症发生率间差异有显著性意义（P <0.05）。全组无死亡病例。结论对于困难插管的 ERCP 病例，应用十二指肠乳头括约肌预切开术是提高插管成功率十分必要的有效方法，然而，预切开技术难度大、风险高，在避免盲目随意应用的基础上，按照摆正乳头、看清轴向、短距离、分层、逐步、点切的要领，由资深内镜医师操作可明显提高预切开术后插管成功率和有效降低并发症的发生率。
목적：총결십이지장유두괄약기예절개술재곤난삽관적내경역행이담관조영술（ERCP）중적림상응용경험급기교。방법회고성분석아과자2010년1월-2013년12월간개전적대우 ERCP 삽관곤난적280례환자실시적십이지장유두괄약기예절개술，안조실시예절개술적선후，장280례환자분성 A、B 량조。A 조위2010년1월-2011년12월，실시예절개술초기적143례병례；B 조위2012년1월-2013년12월，급취전일계단경험교훈，채취파정유두、간청축향、단거리、분층、축보、점절적방법진행적137례병례。비교량계단예절개술후적삽관성공솔급병발증발생솔，총결십이지장유두괄약기예절개술적조작경험급기교。결과 A 조143례예절개술후삽관성공113례，성공솔79.02%，천공5례，발생솔3.49%，출혈4례，발생솔2.80%，급성이선염6례，발생솔4.20%，무급성담관염급급성담낭염발생，총적병발증발생솔10.49%。B 조137례예절개술후삽관성공134례，성공솔97.81%，천공1례，발생솔0.73%，무소화도출혈병례，급성이선염3례，발생솔2.19%，무급성담관염급급성담낭염발생，총적병발증발생솔2.92%。A 조여 B 조비교，예절개술후삽관성공솔급총적병발증발생솔간차이유현저성의의（P <0.05）。전조무사망병례。결론대우곤난삽관적 ERCP 병례，응용십이지장유두괄약기예절개술시제고삽관성공솔십분필요적유효방법，연이，예절개기술난도대、풍험고，재피면맹목수의응용적기출상，안조파정유두、간청축향、단거리、분층、축보、점절적요령，유자심내경의사조작가명현제고예절개술후삽관성공솔화유효강저병발증적발생솔。
Objective To summarize the experience and clinical skills of duodenum pre-cut sphincterotomy in difficult endoscopic retrograde cholangiopancreatography(ERCP)cannulation. Methods Retrospectively analyzed 280 patients who had been performed precut sphincterotomy in difficult ERCP cannulation in our department during Jan. 2010 to Dec. 2013. The patients were divided into two groups according to the time that they were performed precut sphincterotomy. Group A is the first stage,which includes 143 patients during Jan. 2010 to Dec. 2011. Group B is the second stage,which includes 137 patients during Jan. 2012 to Dec. 2013. And the skills of second stage of precut sphincterotomy were modified according to the experience of the first stage. We compared the success rate and morbidity rate of the two stages and summarized the skills of precut sphincterotomy. Results In group A,113 of 143 patients were performed precut sphincterotomy successfully,the success rate is 79. 02% . Duodenal perforation occurred in 5 of 143 patients,and the perforation rate is 3. 49% . Hemorrhage occurred in 4 of 143 patients, and the rate is 2. 80% . Acute pancreatitis occurred in 6 of 143 patients,and the rate is 4. 20% . No acute cholangitis and acute cholecystitis occurred. The total morbidity rate for group A is 10. 49% . In group B, 134 of 137 patients were performed precut sphincterotomy successfully,the success rate is 97. 81% . Duodenal perforation occurred in 1 of 137 patients,and the perforation rate is 0. 73% . No upper gastrointestinal bleeding occurred. Acute pancreatitis occurred in 3 of 137 patients,and the rate is 2. 19% . No acute cholangitis and acute cholecystitis occurred. The total morbidity rate for group B is 2. 92% . Group B has a significantly higher success rate and lower morbidity rate of precut sphincterotomy(P < 0. 05). No death occurred in both groups. Conclusion Precut sphincterotomy is an effective procedure for difficult ERCP cannulation,but precut sphincterotomy is technically difficult and high risk. So avoiding perform precut sphincterotomy blindlessly,and perform the procedure according to the skills,and by experienced endoscopists could improve the success rate and lower the morbidity rate significantly.