Miao Lin, Li Quan-Peng, Zhu Ming-Hui, Ge Xian-Xiu, Yu Hong, Wang Fei, Ji Guo-Zhong
Lin Miao, Quan-Peng Li, Xian-Xiu Ge, Hong Yu, Fei Wang, Guo-Zhong Ji, Institute of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China.
World J Gastroenterol. 2015 Apr 7;21(13):3978-82. doi: 10.3748/wjg.v21.i13.3978.
To evaluate the technique of transpancreatic septotomy (TS) for cannulating inaccessible common bile ducts in endoscopic retrograde cholangiopancreatography (ERCP).
Between May 2012 and April 2013, 1074 patients were referred to our department for ERCP. We excluded 15 patients with previous Billroth II gastrectomy, Roux-en-Y anastomosis, duodenal stenosis, or duodenal papilla tumor. Among 1059 patients who underwent ERCP, there were 163 patients with difficult bile duct cannulation. Pancreatic guidewire or pancreatic duct plastic stent assistance allowed for successful ERCP completion in 94 patients. We retrospectively analyzed clinical data from 69 failed patients (36 transpancreatic septotomies and 33 needle-knife sphincterotomies).
Of the 69 patients who underwent precut papillotomy, common bile duct cannulation was successfully achieved in 67. The success rates in the TS and needle knife sphincterotomy (NKS) groups were 97.2% (35/36) and 96.9% (32/33), respectively, which were not significantly different (P > 0.05). Complications occurred in 11 cases, including acute pancreatitis (n = 6), bleeding (n = 2), and cholangitis (n = 3). The total frequency of complications in the TS group was lower than that in the NKS group (8.3% vs 24.2%, P < 0.05).
Pancreatic guidewire or pancreatic duct plastic stent assistance improves the success rate of selective bile duct cannulation in ERCP. TS and NKS markedly improve the success rate of selective bile duct cannulation in ERCP. TS precut is safer as compared with NKS.
评估经胰管隔膜切开术（TS）在内镜逆行胰胆管造影术（ERCP）中用于插管难以到达的胆总管的技术。
2012年5月至2013年4月期间，1074例患者被转诊至我科进行ERCP。我们排除了15例曾接受毕Ⅱ式胃切除术、Roux-en-Y吻合术、十二指肠狭窄或十二指肠乳头肿瘤的患者。在1059例行ERCP的患者中，有163例存在胆管插管困难。94例患者通过胰管导丝或胰管塑料支架辅助成功完成了ERCP。我们回顾性分析了69例失败患者（36例行经胰管隔膜切开术和33例行针刀括约肌切开术）的临床资料。
在69例行预切开乳头切开术的患者中，67例成功实现了胆总管插管。TS组和针刀括约肌切开术（NKS）组的成功率分别为97.2%（35/36）和96.9%（32/33），差异无统计学意义（P>0.05）。发生并发症11例，包括急性胰腺炎（n=6）、出血（n=2）和胆管炎（n=3）。TS组并发症的总发生率低于NKS组（8.3%对24.2%，P<0.05）。
胰管导丝或胰管塑料支架辅助提高了ERCP中选择性胆管插管的成功率。TS和NKS显著提高了ERCP中选择性胆管插管的成功率。与NKS相比，TS预切开更安全。
