Khatibian Morteza, Sotoudehmanesh Rasoul, Ali-Asgari Ali, Movahedi Zohreh, Kolahdoozan Shadi
Digestive Diseases Research Center, Medical Sciences/University of Tehran, Tehran, Iran.
Arch Iran Med. 2008 Jan;11(1):16-20.
Endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy has become widely available for the treatment of pancreatobiliary diseases; however, it has mortality and complications. The aim of this study was to compare the success rates and complications of two different methods of common bile duct cannulation.
From June 2003 though February 2004, patients who were candidates for endoscopic retrograde cholangiopancreatography and/or endoscopic sphincterotomy were randomly divided into two groups: standard cannulation (group A) and suprapapillary needle-knife fistulotomy (group B). Postendoscopic retrograde cholangiopancreatography pancreatitis, cholangitis, bleeding, and perforation were evaluated.
Two hundred and eighteen cases (86 males and 132 females with a mean+/-SD age of 56.2+/-17.5 years) were enrolled in this study. Group A, contained 112 patients and group B included 106 patients. In group A, the final cannulation success was achieved in 100 patients (89.3%). Cannulation was successful in 88 patients (83.0%) in group B. Difficulty in cannulation occurred more frequently in group A (25.5% vs. 2.6%, P=0.002). There were two patients in group B and three patients in group A who developed pancreatitis after endoscopic retrograde cholangiopancreatography. Perforation occurred in one patient in group B, which was improved with medical support. Bleeding and cholangitis were not occurred in any of the groups. The overall complication rate was 3/112 in group A and 3/106 in group B.
Needle-knife fistulotomy is safe and can be applied as an effective alternative to standard technique for common bile duct cannulation in expert hands.
内镜逆行胰胆管造影术及内镜括约肌切开术已广泛应用于胰胆疾病的治疗；然而，该手术存在死亡率及并发症。本研究旨在比较两种不同胆总管插管方法的成功率及并发症。
2003年6月至2004年2月，将适合内镜逆行胰胆管造影术和/或内镜括约肌切开术的患者随机分为两组：标准插管组（A组）和乳头上方针刀瘘管切开术组（B组）。评估内镜逆行胰胆管造影术后胰腺炎、胆管炎、出血及穿孔情况。
本研究共纳入218例患者（86例男性，132例女性，平均年龄56.2±17.5岁）。A组112例患者，B组106例患者。A组100例患者（89.3%）最终插管成功。B组88例患者（83.0%）插管成功。A组插管困难发生率更高（25.5%对2.6%，P = 0.002）。B组2例患者、A组3例患者内镜逆行胰胆管造影术后发生胰腺炎。B组1例患者发生穿孔，经药物支持后好转。两组均未发生出血及胆管炎。A组总体并发症发生率为3/112，B组为3/106。
针刀瘘管切开术安全，在经验丰富者手中可作为胆总管插管标准技术的有效替代方法应用。
