Zhou Ping-Hong, Yao Li-Qing, Xu Mei-Dong, Zhong Yun-Shi, Gao Wei-Dong, He Guo-Jie, Zhang Yi-Qun, Chen Wei-Feng, Qin Xin-Yu
Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Hepatobiliary Pancreat Dis Int. 2006 Nov;5(4):590-4.
Getting directly into the common bile duct (CBD) is the most important step for successful therapeutic biliary endoscopy. In 5%-10% of cases, the CBD remains inaccessible, necessitating pre-cut papillotomy or fistulotomy with a needle-knife. The aim of this study was to assess the value of early application of the needle-knife in difficult biliary cannulation for endoscopic retrograde cholangiopancreatography (ERCP).
Patients with failed biliary cannulation after 10 minutes or guide wire entering the pancreatic tube 3 times were randomly divided into group of needle-knife cut and group of persistent cannulation by standard techniques. The cannulation times, success rates and complication rates were compared between the two groups.
A total of 948 therapeutic biliary ERCP procedures were performed between October 2004 and February 2006. Of 91 patients with difficult biliary cannulation, 43 patients underwent needle-knife cut: the cannulation success rate was 90.7%, the mean cannulation time was 5.6 minutes, and the complication rate was 9.3%. The other 48 patients underwent persistent cannulation by standard techniques: the cannulation success rate was 75%, the mean cannulation time was 10.2 minutes, and the complication rate was 14.6%. Significant differences were observed in cannulation success rate and cannulation time but in complication rate between the two groups.
The early application of the needle-knife in difficult biliary cannulation is time-saving, safe and effective, with no increase in complication rate.
直接进入胆总管（CBD）是成功进行治疗性胆道内镜检查的最重要步骤。在5%-10%的病例中，胆总管难以进入，需要进行预切开乳头切开术或用针刀进行瘘管切开术。本研究的目的是评估在困难的胆道插管中早期应用针刀对内镜逆行胰胆管造影（ERCP）的价值。
胆道插管10分钟失败或导丝3次进入胰管的患者被随机分为针刀切开组和采用标准技术持续插管组。比较两组的插管时间、成功率和并发症发生率。
2004年10月至2006年2月共进行了948例治疗性胆道ERCP手术。在91例胆道插管困难的患者中，43例患者接受了针刀切开：插管成功率为90.7%，平均插管时间为5.6分钟，并发症发生率为9.3%。另外48例患者采用标准技术持续插管：插管成功率为75%，平均插管时间为10.2分钟，并发症发生率为14.6%。两组在插管成功率和插管时间上存在显著差异，但在并发症发生率上无显著差异。
在困难的胆道插管中早期应用针刀省时、安全、有效，且不增加并发症发生率。
