Leung J W, Banez V P, Chung S C
Department of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T.
Am J Gastroenterol. 1990 Aug;85(8):991-3.
Twenty of 510 patients with common bile duct (CBD) stone underwent needle knife precut papillotomy after conventional papillotomy failed because of impacted ampullary stone. This facilitated deep cannulation and subsequent standard papillotomy in 12 patients. In four patients, the precut papillotomy was extended, resulting in spontaneous expulsion of stone. Bleeding precluded stone extraction in three patients, and these stones were removed at a second ERCP session. Ductal clearance was achieved in all except one patient who underwent surgical removal of the impacted stone. Mild bleeding occurred in four patients and was successfully controlled by endoscopic adrenalin injection. There was no perforation, pancreatitis, or exacerbation of cholangitis following the procedure.
510例胆总管结石患者中，20例在常规乳头切开术因壶腹结石嵌顿失败后接受了针刀预切开乳头括约肌切开术。这使得12例患者能够顺利进行深部插管及随后的标准乳头切开术。4例患者的预切开乳头括约肌切开术范围扩大，结石自行排出。3例患者因出血未能取出结石，这些结石在第二次内镜逆行胰胆管造影（ERCP）时被取出。除1例接受手术取出嵌顿结石的患者外，其余患者均实现了胆管清除。4例患者出现轻度出血，通过内镜下注射肾上腺素成功控制。术后未发生穿孔、胰腺炎或胆管炎加重。
