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首页> 外文期刊>Surgical Endoscopy >Pancreatic sphincterotomy versus needle knife precut in difficult biliary cannulation.
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Pancreatic sphincterotomy versus needle knife precut in difficult biliary cannulation.

机译：胰括约肌切开术与针刀切开在困难的胆管插管中比较。

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BACKGROUND: In endoscopic retrograde cholangiopancreaticography (ERCP) difficult cannulation is an independent risk factor for complications. METHODS: Altogether 6,209 ERCPs were performed in Helsinki University Central Hospital in the period 1996-2006. In 558 cases (9%) without a previous sphincterotomy, direct access into the biliary duct could not be achieved. In this group access was attempted by first performing a pancreatic sphincterotomy in 351 difficult cannulation cases (63%). A needle knife precut without a pancreatic sphincterotomy was performed in 178 cases (32%). All the necessary clinical and laboratory information was available for 262 of the 351 patients who had undergone a pancreatic sphincterotomy and for 157 of the 178 patients who had been subjected to needle knife precutting, and these data were further evaluated in this study. RESULTS: The pancreatic sphincterotomy technique was successful in 255 cases (97.3%). Post-ERCP pancreatitis developed in 8.8% of the pancreatic sphincterotomy group. In 147 patients, biliary cannulation was successful following a pancreatic sphincterotomy, and the post-ERCP pancreatitis rate for those patients was 9.3%. In 108 patients, a needle knife papillotomy, in addition to a pancreatic sphincterotomy, was necessary and resulted in a post-ERCP pancreatitis rate of 8.2%. In the needle knife precut group only, post-ERCP pancreatitis developed in 5.1% of cases. Biliary cannulation succeeded less frequently following needle knife precutting than following the pancreatic sphincterotomy technique (71.3% versus 97.3%, p<0.001). There was no significant difference in the post-ERCP pancreatitis rate between the precut and pancreatic sphincterotomy techniques (p=0.16). CONCLUSIONS: In difficult cannulation, a pancreatic sphincterotomy to achieve deep biliary duct cannulation can be performed with a high success rate (failure rate less than 3%). The corresponding success rate using the needle knife precut technique is 71%. In both methods the risk for post-ERCP pancreatitis is comparable to that of a standard biliary sphincterotomy.
机译：背景：在内镜逆行胰胆管造影（ERCP）中，插管困难是并发症的独立危险因素。方法：1996-2006年期间，在赫尔辛基大学中心医院共进行了6209例ERCP。在558例（9％）未做过括约肌切开术的患者中，无法直接进入胆管。在该组中，首先尝试对351例困难的插管病例（63％）进行胰括约肌切开术。 178例（32％）进行了无胰腺括约肌切开术的针刀预切。 351例接受了括约肌切开术的患者中的262例以及178例接受了针刀预切的患者中的157例，都获得了所有必要的临床和实验室信息，这些数据在本研究中得到了进一步评估。结果：胰腺括约肌切开术成功255例，占97.3％。胰腺括约肌切开术组中有8.8％发生了ERCP后胰腺炎。在147例患者中，胰腺括约肌切开术后胆管插管成功，这些患者的ERCP术后胰腺炎发生率为9.3％。在108例患者中，除了进行胰腺括约肌切开术以外，还需要进行针刀乳头切开术，导致ERCP后胰腺炎的发生率为8.2％。仅在针刀切开组中，发生ERCP后的胰腺炎发生率为5.1％。针刀预切后胆管插管的成功率比胰括约肌切开术低（71.3％vs 97.3％，p <0.001）。预切和胰腺括约肌切开术之间的ERCP后胰腺炎发生率无显着差异（p = 0.16）。结论：在困难的插管中，可以进行胰括约肌切开术以实现深胆管插管，并且成功率很高（失败率低于3％）。使用针刀预切技术的相应成功率为71％。在这两种方法中，ERCP后胰腺炎的风险均与标准胆道括约肌切开术的风险相当。

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