经胰管弓式隔膜乳头预切开术和针式乳头预切开术在困难胆管插管中的应用研究

目的评价经胰管弓式隔膜乳头预切开术处理ERCP困难胆管插管的应用价值。方法回顾2006年1月至2008年7月109例ERCP胆总管插管困难患者进行经胰管弓式隔膜乳头预切开术（下称经胰管组，56例）和常规针式乳头预切开术（下称常规针刀组，53例）的临床资料，比较两种方法插管成功率及并发症发生率。结果109例患者中的97例在乳头预切开术后可成功插入胆管，经胰管组成功率96．4％（54／56），常规针刀组成功率81．1％（43／53），两者差异具统计学意义（P〈0．05）。109例中11例出现并发症，包括急性胰腺炎5例、出血4例、胆道感染2例。其中，经胰管组急性胰腺炎2例，常规针刀组急性胰腺炎3例，出血4例，胆道感染2例。两组比较，经胰管组总的并发症发生率低于常规针刀组（3．6％比17．0％，P〈0．05），术后胰腺炎、出血、感染发生率也分别低于后者，但均无统计学意义。结论内镜经胰管弓式隔膜乳头预切开术超选胆总管成功率高于针式乳头预切开术，而且并发症较低，是处理选择性胆总管插管较困难患者的安全和有效的办法。

Endoscopic precut sphincterotomy for cannulation of inaccessible common bile duct: transpancreatic septum precut versus needle-knife

Objective To evaluate the technique of transpancreatic septum precut for cannulation of inaccessible common bile duct in endoscopic retrograde cholangiopancreatography (ERCP). Methods Data of 109 patients with difficult biliary cannulation in ERCP, of whom 56 underwent transpancreatic septum precut and 53 had needle-knife sphincterotomy from January 2006 to July 2008, were analyzed retrospectively, and the success rate of cannulation and the occurrence of complications were compared between the two methods. Results Of 109 patients accepted precut papillotomy, common bile duct cannulation was successfully achieved in 97. The success rates of transpancreatic septum precut group and needle-knife sphincterotomy group were 96.4% (54/56) and 81.1% (43/53) respectively, which was significantly different (P<0.05). Complications occurred in 11 cases, including bleeding(n =4), acute pancreatitis(n=5), cholangitis(n=2). The tolal frequency of complications of the transpancreatic septum pre-cut papillotomy group was lower than that of needle-knife sphincterotomy group(3.6% vs. 17.0%, P<0.05). Conclusion In patients with inaccessible bile ducts, transpancreatic septum precut is a safe and effective procedure in cannulation, exhibiting a higher success rate and lower occurrence of complication when compared with needle-knife sphincterotomy.