针形刀预切开术在老年患者胆道远端恶性狭窄支架置入中的应用

Application about precut of needle knife in stent implantation for malignant distal biliary stricture in elderly patients

摘要:

目的 研究针形刀预切开术在老年胆管远端恶性狭窄患者中行内镜逆行胰胆管造影术（ERCP）支架置入的应用效果。方法 选取常州市第一人民医院2018年1月－2021年1月47例明确诊断为胆管远端恶性狭窄且常规插管失败而行针形刀预切开术的老年患者（年龄 > 70岁）。其中，男29例，女18例；年龄71～93岁，平均81.04岁；十二指肠乳头癌6例，胰腺癌19例，胆管远端癌14例，恶性肿瘤多发转移压迫胆道8例；5例患者曾行毕Ⅰ式胃大部切除术。结果 所有患者均成功行针形刀预切开术，同时完成了ERCP下胆管支架置入；术后高淀粉酶血症发生率为6.38%，急性胰腺炎4.26%，迟发性出血2.13%；术后1周复查胆红素和酶学指标，均明显改善。结论 对于胆道远端恶性狭窄合并ERCP插管困难的老年患者，针形刀预切开术可以有效提高ERCP插管成功率。

Abstract:

Objective To investigate the application about precut of needle knife in stent implantation through endoscopic retrograde cholangiopancreatography (ERCP) for malignant distal biliary stricture in elderly patients.Methods From January 2018 to January 2021, 47 elderly patients ( > 70 years old) who were clearly diagnosed as distal malignant bile duct stenosis and underwent needle-knife pretomy due to routine intubation failure were selected. Among them, 29 males and 18 females; The age range was 71 to 93, The average age was 81.04 years; 6 cases were duodenal papillary carcinoma, 19 cases were pancreatic carcinoma, 14 cases were distal bile duct carcinoma, 8 cases were multiple metastasis of malignant tumors compressing the bile duct. Five patients had underwent Billroth Ⅰ gastrectomy.Results All these patients were successfully treated with needle-knife pretomy, at the same time, biliary stent implantation through ERCP was also completed; The incidence of postoperative hyperamylasemia was 6.38%, acute pancreatitis was 4.26%, delayed hemorrhage was 2.13%, and the bilirubin and enzyme indexes were significantly declined in one week after operation.Conclusion For the elderly patients with difficult cannulation of malignant stricture of distal bile duct, precut of needle knife can effectively improve the success rate of ERCP.