World J Gastroenterol. 2013 Jan 7;19(1):1-7. doi: 10.3748/wjg.v19.i1.1.
Even experienced endoscopists have 90% success in achieving deep biliary cannulation with standard methods. Biliary cannulation may become difficult in 10%-15% of patients with biliary obstruction and precut (access) sphincterotomy is frequently chosen as a rescue treatment in these cases. Generally, precut sphincterotomy ensures a rate of 90%-100% successful deep biliary cannulation. The precut technique has been performed as either a fistulotomy with a needle knife sphincterotome or as a transpapillary septotomy with a standard sphincterotome. Both methods have similar efficacy and complication rates when administered to the proper patient. Although precut sphincterotomy ensures over 90% success of biliary cannulation, it has been characterized as an independent risk factor for pancreatitis. The complications of the precut technique are not limited to pancreatitis. Two more important ones, bleeding and perforation, are also reported in some publications as being observed more commonly than during standard sphincterotomy. It is also reported that precut sphincterotomy increases morbidity when performed in patients without dilatation of their biliary tract. Nevertheless, precut sphincterotomy is a good alternative as a rescue method in the setting of a failed standard cannulation method. This paper discusses the technical details, timing, efficacy and potential complications of precut sphincterotomy.
即使是经验丰富的内镜医生，使用标准方法进行胆管深度插管的成功率也只有 90%。在 10%-15%的胆道梗阻患者中，胆管插管可能会变得困难，在这些情况下，通常会选择预切开（进入）括约肌切开术作为抢救治疗。一般来说，预切开括约肌切开术可确保 90%-100%的胆管深度插管成功率。预切开技术可以采用针状刀括约肌切开术进行瘘管切开术，也可以采用标准括约肌切开术进行经乳头隔切开术。当应用于适当的患者时，这两种方法的疗效和并发症发生率相似。虽然预切开括约肌切开术可确保胆管插管成功率超过 90%，但它已被确定为胰腺炎的独立危险因素。预切开技术的并发症不仅限于胰腺炎。在一些出版物中，还报道了另外两个更重要的并发症，即出血和穿孔，其发生率比标准括约肌切开术更高。还有报道称，在未扩张胆道的患者中进行预切开括约肌切开术会增加发病率。然而，在标准插管方法失败的情况下，预切开括约肌切开术是一种很好的抢救方法。本文讨论了预切开括约肌切开术的技术细节、时机、疗效和潜在并发症。
