Precut技术在胆胰疾病治疗性内镜下逆行 胰胆管造影术中的应用价值

The role of therapeutic ERCP in the treatment of biliary-pancreatic diseases with Precut technique

摘要:

目的 探讨治疗性内镜下逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography，ERCP）在胆胰系统疾病中的治疗价值。方法 对2004年2月～2011年11月的 1 328例经内镜下逆行胰胆管造影术ERCP治疗的病例资料进行回顾性分析，对经ERCP治疗中插管困难者运用Precut技术（乳头预切开技术，包括乳头弓形刀乳头括约肌预切开术、经胰管弓形刀乳头括约肌预切开术、针状刀乳头括约肌预切开术或针状刀乳头括约肌开窗术辅助插管及取石），使部分ERCP插管困难的病例均取得成功，评价治疗性ERCP在各种胆胰疾病中的应用价值。结果 治疗病例中胆管结石最多，占65.13%,其次为恶性胆道梗阻，占18.56%，乳头良性狭窄占9.35%，急性胆源性胰腺炎占8.45%，急性梗阻性化脓性胆管炎占7.25%，医源性胆道损伤占2.52%，慢性胰腺炎占2.11%，胆道蛔虫占0.26%，其他0.16%。并发症发生率3.12%，其中穿孔3例,死亡1例。结论 治疗性 ERCP对多种胆胰疾病疗效确切，是一种安全有效的胆胰疾病治疗手段，Precut技术是ERCP插管困难病例达到插管成功的有效、安全的办法，可由有经验的消化内镜医生应用于确实有需要进行治疗性ERCP的病例。

Abstract:

【Objective】 To evaluate the role of therapeutic ERCP in the treatment of biliary-pancreatic diseases. 【Methods】 1328 cases treated with therapeutic ERCP from February 2004 to November 2011, were retrospectively reviewed of its role in the treatment of various biliary-pancreatic diseases. All the cases couldn’t achieve deep CBD cannulation although guidewire cannulation technique was used. The precutting techniques include precut papillotomy, transpancreatic precut sphincterotomy, needle-knife precut sphincterotomy and needle-knife fistulotomy. The standard endoscopic sphincterotomy would be performed after precut procedure if needed. 【Results】 ERCP was used to treat bile duct stone 65.13%, malignant biliary obstruction 18.56%, benign papillary stricture 9.35%, acute biliarypancreatitis 8.45%, acute obstructive suppurative cholangitis 7.25%, iatrogenic biliary injury 2.52%, chronic pancreatitis 2.11%, biliary tract ascariasis 0.26% and others 0.16%. Complication incidence was 3.12% and a case died from perforation. 【Conclusion】 Therapeutic ERCP is an effective and safe treatment for various biliary-pancreatic diseases, Precut is an effective and safe technique in difficult biliary cannulation. It can be used in experienced hands when clinically indicated on therapeutic ERCP.