Kasmin F E, Cohen D, Batra S, Cohen S A, Siegel J H
Beth Israel Medical Center, New York, New York, USA.
Gastrointest Endosc. 1996 Jul;44(1):48-53. doi: 10.1016/s0016-5107(96)70228-6.
The use of needle-knife sphincterotomy as a method of precut sphincterotomy has been criticized as potentially unsafe. Despite this, a number of tertiary referral centers have reported their successful use of this technique to increase the rate of common bile duct cannulation.
We assessed the safety and efficacy of needle-knife sphincterotomy in 72 consecutive patients in whom attempts at standard common bile duct cannulation were unsuccessful. Bile duct diameters were correlated to the complication rate.
Cannulation of the common bile duct was successful immediately after needle-knife sphincterotomy in 50 patients (67%), and was successful in 17 of the 20 patients who underwent repeat ERCP, for a total cannulation rate of 93%. Eight patients (11%) experienced complications. Retroduodenal perforation during guide wire cannulation attempts and bleeding occurred as frequently as pancreatitis. Small duct size was a risk factor for complications. There was no procedure-related mortality, and all complications were managed medically.
Needle-knife sphincterotomy was effective in facilitating cannulation in patients in whom standard cannulation attempts failed. Limiting guide wire manipulation of the fresh sphincterotomy site and excluding patients with small duct size may further reduce the complication rate.
针状刀括约肌切开术作为一种预切开括约肌切开术的方法，被批评为可能不安全。尽管如此，一些三级转诊中心报告了他们成功使用该技术提高胆总管插管率的情况。
我们评估了连续72例标准胆总管插管尝试失败患者的针状刀括约肌切开术的安全性和有效性。将胆管直径与并发症发生率进行关联分析。
50例患者（67%）在针状刀括约肌切开术后立即成功进行了胆总管插管，20例接受重复内镜逆行胰胆管造影（ERCP）的患者中有17例成功，总插管率为93%。8例患者（11%）出现并发症。导丝插管尝试期间的十二指肠后穿孔和出血与胰腺炎的发生率相当。小胆管尺寸是并发症的一个危险因素。没有与手术相关的死亡病例，所有并发症均通过药物治疗。
针状刀括约肌切开术对于标准插管尝试失败的患者促进插管有效。限制对新鲜括约肌切开部位的导丝操作并排除小胆管尺寸的患者可能会进一步降低并发症发生率。
