Vihervaara Hanna, Grönroos Juha M
Department of Surgery, University of Turku, Turku, Finland.
Surg Laparosc Endosc Percutan Tech. 2012 Apr;22(2):161-4. doi: 10.1097/SLE.0b013e318247bb84.
Traditionally, a 2-step protocol has been used for deep biliary cannulation. The purpose of the present prospective study was to find out the feasibility and safety of the novel sequential 3-step protocol (traditional cannula with guidewire, double-guidewire, and needle-knife techniques) for deep biliary cannulation. All consecutive patients admitted for endoscopic retrograde cholangiopancreatography (ERCP) to a single, very experienced ERCP endoscopist during the year 2009 with intended biliary cannulation and with unhindered access to a native papilla (n=105) were included in the present study. The overall success rate for deep biliary cannulation was 99% (104/105). Cannulation with cannula and guidewire was attempted in all patients and proved successful in 80% (84/105) of the attempts, the double-guidewire technique was applied in 19% (20/105) and was successful in 65% (13/20) of the cases, and the needle-knife technique was applied in 7% (7/105) with success in all cases. The median cannulation time was 1 minute (range, 0 to 27 min). The rate of post-ERCP pancreatitis was 3% (3/105) and post-ERCP cholangitis 2% (2/105). We conclude that in experienced hands, the novel sequential 3-step protocol for biliary cannulation tested herein proved to be an effective cannulation protocol with the overall success rate of 99%. The complication rate of these ERCP procedures (5%) was within acceptable limits.
传统上，深胆管插管采用两步法。本前瞻性研究的目的是探究新型序贯三步法（传统插管带导丝、双导丝及针刀技术）用于深胆管插管的可行性和安全性。纳入2009年期间因内镜逆行胰胆管造影术（ERCP）入住同一经验丰富的ERCP内镜医师处、拟行胆管插管且能顺利进入天然乳头的所有连续患者（n = 105）。深胆管插管的总体成功率为99%（104/105）。所有患者均尝试插管带导丝，80%（84/105）的尝试成功；19%（20/105）应用双导丝技术，其中65%（[13/20]）成功；7%（7/105）应用针刀技术，所有病例均成功。插管中位时间为1分钟（范围0至27分钟）。ERCP术后胰腺炎发生率为3%（3/105），ERCP术后胆管炎发生率为2%（2/105）。我们得出结论，在经验丰富者手中，本文所测试的新型序贯三步胆管插管法被证明是一种有效的插管方法，总体成功率为99%。这些ERCP操作的并发症发生率（5%）在可接受范围内。
