Maple John T, Keswani Rajesh N, Edmundowicz Steven A, Jonnalagadda Sreenivasa, Azar Riad R
Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73117, USA.
Gastrointest Endosc. 2009 Jan;69(1):47-54. doi: 10.1016/j.gie.2008.04.010. Epub 2008 Jul 25.
Recommended techniques for minor papilla sphincterotomy include performing a standard pull-type sphincterotomy (PTS) or using a needle-knife over a stent. A wire-assisted access sphincterotomy (WAAS) technique may hold some technical advantages over these accepted methods, but has not been robustly described.
To describe the safety and efficacy of WAAS compared with PTS in a series of patients from our institution.
Retrospective audit of initial minor papilla sphincterotomies over a 6-year period. Demographic and procedural data were abstracted, and the medical record was reviewed for clinical follow-up.
A large tertiary referral center.
One hundred twenty-eight consecutive patients with pancreas divisum who underwent ERCPs between April 2001 and April 2007, 64 of whom underwent an initial minor papilla sphincterotomy.
WAAS was performed by deeply cannulating the dorsal duct with a guidewire and then passing a needle-knife sphincterotome alongside the wire and cutting the minor papilla by inserting the needle-knife beside the wire and cutting away from the wire.
Clinical procedural success and reported adverse events.
Thirty-two patients had recurrent acute pancreatitis, 15 had pain only, and 13 had chronic pancreatitis. Thirty-two underwent WAAS, 24 had PTS, and 8 had other types of sphincterotomies. Patients undergoing WAAS (32) versus PTS (24) were similar in age, sex, and procedural indication. Mild post-ERCP pancreatitis and mild intraprocedural bleeding occurred more commonly in the WAAS group, although the differences were not statistically significant.
Retrospective, nonrandomized study.
WAAS is an effective technique that may be used either to begin a minor papilla sphincterotomy or to perform the entire sphincterotomy. Complications appear similar to those seen with conventional methods but require a larger patient sample to fully evaluate.
小乳头括约肌切开术的推荐技术包括实施标准的牵引式括约肌切开术（PTS）或在支架上使用针刀。与这些公认的方法相比，钢丝辅助进入括约肌切开术（WAAS）技术可能具有一些技术优势，但尚未得到充分描述。
在我们机构的一系列患者中，描述WAAS与PTS相比的安全性和有效性。
对6年期间最初的小乳头括约肌切开术进行回顾性审计。提取人口统计学和手术数据，并查阅病历以进行临床随访。
一家大型三级转诊中心。
2001年4月至2007年4月期间连续128例胰腺分裂症患者接受了内镜逆行胰胆管造影（ERCP），其中64例接受了初次小乳头括约肌切开术。
通过用导丝深入插入背侧胰管进行WAAS，然后将针刀括约肌切开刀沿导丝送入，将针刀插入导丝旁并远离导丝进行切割，从而切开小乳头。
临床手术成功率和报告的不良事件。
32例患者有复发性急性胰腺炎，15例仅有疼痛，13例有慢性胰腺炎。32例接受WAAS，24例接受PTS，8例接受其他类型的括约肌切开术。接受WAAS（32例）与PTS（24例）的患者在年龄、性别和手术指征方面相似。尽管差异无统计学意义，但轻度ERCP后胰腺炎和轻度术中出血在WAAS组中更常见。
回顾性、非随机研究。
WAAS是一种有效的技术，可用于开始小乳头括约肌切开术或进行整个括约肌切开术。并发症似乎与传统方法相似，但需要更大的患者样本进行全面评估。
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