Abu-Hamda Emad M, Baron Todd H, Simmons Dia T, Petersen Bret T
Division of Gastroenterology and Hepatology, Mayo Clinic, College of Medicine, Rochester, MN 55905, USA.
J Clin Gastroenterol. 2005 Sep;39(8):717-21. doi: 10.1097/01.mcg.0000173928.82986.56.
To assess the outcome differences following different precut biliary sphincterotomy needle-knife techniques.
Precut biliary needle-knife sphincterotomy (NKS) allows biliary access when standard cannulation techniques fail. Little comparative data exist on the outcome of precut NKS.
Retrospective comparison of outcome differences of three NKS techniques performed by three pancreaticobiliary endoscopists at a tertiary referral center.
A total of 139 consecutive biliary NKS were performed. In 44 cases (technique A), NKS was performed using a precut fistulotomy technique avoiding the papillary orifice, with pure cutting current, and occasional pancreatic duct (PD) stenting (6 of 44). In 47 cases (technique B), NKS was performed starting from the papillary orifice cutting upward with blended current, and no PD stenting. In 48 cases (technique C), NKS was performed as B but using pure cutting current and frequent PD stenting (15 of 48). NKS was successful in 95.5%, 95.7%, and 89.6% at initial endoscopic retrograde cholangiopancreatography and 100%, 97.8%, and 95.6% after a second endoscopic retrograde cholangiopancreatography. Total complications were not significantly different between the three groups; however, a lower incidence of pancreatitis occurred using technique A compared with techniques B and C (not significant).
NKS techniques result in a high success rate of biliary cannulation with a similar overall complication rate. Avoiding cutting at the papillary orifice may reduce the risk of pancreatitis. When cutting at the papillary orifice, pancreatic duct stenting, pure cutting current, or both may reduce the incidence of pancreatitis.
评估不同预切开胆管括约肌切开术针刀技术后的结果差异。
当标准插管技术失败时，预切开胆管针刀括约肌切开术（NKS）可实现胆管通路。关于预切开NKS的结果，比较数据很少。
在一家三级转诊中心，对三位胰胆管内镜医师实施的三种NKS技术的结果差异进行回顾性比较。
共进行了139例连续性胆管NKS。在44例（技术A）中，采用预切开瘘管切开术技术进行NKS，避开乳头开口，使用纯切割电流，偶尔进行胰管（PD）支架置入（44例中的6例）。在47例（技术B）中，从乳头开口开始向上切割进行NKS，使用混合电流，不进行PD支架置入。在48例（技术C）中，与技术B相同，但使用纯切割电流并频繁进行PD支架置入（48例中的15例）。在初次内镜逆行胰胆管造影时，NKS的成功率分别为95.5%、95.7%和89.6%，在第二次内镜逆行胰胆管造影后分别为100%、97.8%和95.6%。三组之间的总并发症无显著差异；然而，与技术B和C相比，技术A导致的胰腺炎发生率较低（无统计学意义）。
NKS技术导致胆管插管成功率高，总体并发症发生率相似。避免在乳头开口处切割可能降低胰腺炎风险。当在乳头开口处切割时，胰管支架置入、纯切割电流或两者均可降低胰腺炎的发生率。
