Department of Gastroenterology, St Luke's Hospital, Kilkenny, Ireland, UK.
Surg Endosc. 2010 Aug;24(8):1937-40. doi: 10.1007/s00464-010-0881-9. Epub 2010 Feb 5.
Suprapapillary needleknife fistulotomy is performed when standard biliary cannulation methods have failed. However, its role is controversial, with conflicting reports on its use. This study aimed to determine the efficacy and safety of needleknife fistulotomy after failure of conventional cannulation techniques.
All patients who underwent needleknife fistulotomy were identified from a single tertiary referral center database prospectively maintained from 1997 to 2007.
A total of 2,603 patients underwent endoscopic retrograde cholangiopancreatography (ERCP) over the 10-year period. Fistulotomy was performed for 352 patients (13.5%), with 317 of these patients (90.1%) experiencing successful biliary cannulation. With the use of fistulotomy, the total cannulation success rate increased from 79.0 to 91.2% (P < 0.0001). Endoscopic management of choledocholithiasis and hepatobiliary malignancy increased from 48.9 to 55.1% (P < 0.001), and from 12.0 to 16.0% (P < 0.001) for all cases. The complication rate was significantly higher for the patients who underwent fistulotomy than for those who did not (4.8% vs. 2.1%; P < 0.001), which can be explained by a higher rate of mild bleeding in the fistulotomy group. However, no significant difference in pancreatitis or perforation between the two groups was observed. In addition, no fatalities occurred after fistulotomy.
Suprapapillary needleknife fistulotomy is an effective method for accessing the biliary system after failed standard cannulation. Despite a higher rate of mild bleeding, fistulotomy was not associated with an increased risk of serious complications.
当标准的胆道插管方法失败时，会进行经皮肝穿刺胆管造影针状刀窦道切开术。然而，其作用存在争议，关于其使用的报告结果相互矛盾。本研究旨在确定在常规插管技术失败后经皮肝穿刺胆管造影针状刀窦道切开术的疗效和安全性。
从 1997 年至 2007 年期间前瞻性维护的单一三级转诊中心数据库中确定所有接受经皮肝穿刺胆管造影针状刀窦道切开术的患者。
在 10 年期间，共有 2603 例患者接受了内镜逆行胰胆管造影术。共对 352 例患者（13.5%）进行了窦道切开术，其中 317 例（90.1%）患者成功进行了胆道插管。使用窦道切开术，总插管成功率从 79.0%提高到 91.2%（P<0.0001）。内镜治疗胆总管结石和肝胆恶性肿瘤的比例从 48.9%提高到 55.1%（P<0.001），所有病例的比例从 12.0%提高到 16.0%（P<0.001）。与未行窦道切开术的患者相比，行窦道切开术的患者的并发症发生率显著更高（4.8%对 2.1%；P<0.001），这可以解释为窦道切开组轻度出血的发生率更高。然而，两组之间胰腺炎或穿孔的发生率没有显著差异。此外，窦道切开术没有导致死亡。
经皮肝穿刺胆管造影针状刀窦道切开术是一种在标准插管失败后进入胆道系统的有效方法。尽管轻度出血的发生率较高，但窦道切开术与严重并发症的风险增加无关。
