困难胆管插管预切开术的早期应用：一项比较传统技术与改良技术的前瞻性研究

Early institution of pre-cutting for difficult biliary cannulation: a prospective study comparing conventional vs. a modified technique.

作者信息

Kaffes Arthur J, Sriram Parupudi V J, Rao Guduru V, Santosh Darisetti, Reddy D Nageshwar

机构信息

Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.

出版信息

Gastrointest Endosc. 2005 Nov;62(5):669-74. doi: 10.1016/j.gie.2005.05.022.

DOI:10.1016/j.gie.2005.05.022

PMID:16246677

Abstract

BACKGROUND

Pre-cutting techniques have been used to gain biliary access at the expense of an increased complication rate. This may be because of the multiple attempts to achieve cannulation by using standard methods before pre-cutting and causing excess edema and papillary trauma. There are limited data on the early use of pre-cutting techniques.

METHODS

We performed a prospective study of the early introduction of needle-knife techniques in patients with difficult biliary cannulation. Standard biliary cannulation was attempted with a sphincterotome and a guidewire. If this failed within 10 minutes or if there were more than 5 pancreatic cannulations, the needle-knife technique was used. Either a standard method of pre-cutting (below-upward) from the papillary orifice or the modified technique of pre-cutting (above-downward), stopping short of the papillary orifice, was adopted, as per the discretion of the endoscopist. If pre-cutting failed, the cannulation was reattempted 24 to 48 hours later.

RESULTS

A total of 346 therapeutic biliary ERCP procedures were performed between April and August 2003. Of these, 70 patients (20%) (mean age, 54 years; 38 men) underwent needle-knife pre-cut sphincterotomy (16 with the standard technique). In 58 patients (83%), the procedure was successful with the initial pre-cutting, making the total success at initial ERCP 334/346 (96.5%). Nine patients in whom pre-cut failed, returned for a second-attempt ERCP, with 7 completed successfully. The total success rate of pre-cutting was 65/70 (93%). The overall success rate of biliary cannulation, after two ERCP attempts, was 341/346 (98.5%). Six patients had mild bleeding, and one had mild pancreatitis. There was no difference in these complications between the two types of pre-cut techniques.

CONCLUSIONS

The early use of needle knife for difficult biliary cannulation is safe and effective, irrespective of the technique used.

摘要

背景

预切开技术已被用于获取胆管通路，但代价是并发症发生率增加。这可能是因为在预切开之前使用标准方法多次尝试插管，导致过度水肿和乳头损伤。关于早期使用预切开技术的数据有限。

方法

我们对胆管插管困难的患者早期引入针刀技术进行了一项前瞻性研究。尝试使用括约肌切开刀和导丝进行标准胆管插管。如果在10分钟内失败或胰管插管超过5次，则使用针刀技术。根据内镜医师的判断，采用从乳头开口处进行标准的预切开方法（由下向上）或改良的预切开技术（由上向下），在距乳头开口处短距离处停止。如果预切开失败，24至48小时后重新尝试插管。

结果

2003年4月至8月期间共进行了346例治疗性胆管内镜逆行胰胆管造影（ERCP）手术。其中，70例患者（20%）（平均年龄54岁；38例男性）接受了针刀预切开括约肌切开术（16例采用标准技术）。在58例患者（83%）中，初次预切开手术成功，使初次ERCP的总成功率为334/346（96.5%）。9例预切开失败的患者返回进行第二次ERCP尝试，其中7例成功完成。预切开的总成功率为65/70（93%）。两次ERCP尝试后胆管插管的总体成功率为341/346（98.5%）。6例患者有轻度出血，1例有轻度胰腺炎。两种预切开技术在这些并发症方面没有差异。