Precut技术对高龄乳头嵌顿性胆结石患者疗效及安全性研究.docVIP

Precut技术对高龄乳头嵌顿性胆结石患者的疗效及安全性研究 　　【摘要】 目的 探讨Precut技术对高龄乳头嵌顿性胆结石患者的治疗效果及安全性的研究。方法 总结回顾分析2007年1月至2009年12月38例高龄患者ERCP术后确诊乳头嵌顿性胆总管结石的患者,对经内镜逆行胰胆管造影术(ERCP)治疗中插管困难者运用Precut技术辅助插管及取石,行乳头括约肌切开后,结石常能自行脱出。结果 38例高龄ERCP插管困难患者,行Precut技术取石成功率100%,无死亡病例,其中弓形刀切开8例,针状刀切开10例,两刀联合切开20例。结论 治疗性ERCP是乳头嵌顿性胆结石患者一种安全有效的治疗手段,尤其对高龄无法耐受外科手术的患者,这类患者常伴插管及取石困难,Precut技术无疑是取石成功的关键。 　　【关键词】Precut技术;嵌顿性胆总管结石;高龄患者 　　 　　The Efficacy and Safety ofPrecut Technique in Elderly patients of incarcerated biliary calculi in papilla 　　 　　YAN Shan,DENG Yu,LUO Yun-fan, et al.Department of Gastroenterology,the Central Hospital of Huizhou, Guangdong 516001,China 　　【Abstract】 Objective To evaluate the efficacy and safety of the Precut technique in elderly patients of incarcerated biliary calculi in papilla.Methods Retrospectived the study of the 38 elderly patients who finally diagnosed as incarcerated biliany calculi by the endoscopic retrograde cholangio pancreatography(ERCP)from January 2007 to December 2009.All patients with difficult CBD cannulation underwent Precutting technique.In most of patients the incarcerated biliary calculi in papilla could usually fell away automatically after EST.Results The 38 Elderly patients with difficult CBD cannulation underwent Precutting technique.The success rate of endoscopic stone extraction was 100%,and the mortality and morbidity were zero.Eight cases were performed with arciform knife,10 cases were with needle knife,and 20 cases with botharciform andneedle knife.Conclusion Precut is an effective and safe technique for patients in difficult biliary cannulation with incarcerated biliary calculi in papilla.Precut technique is the most important skill for endoscopic stone extraction. 　　【Key words】 　　Precut technique;Incarcerated biliary calculi;The elderly patient 　　 　　胆总管结石嵌顿是胆道系统常见的急症,随着人群老年化,高龄嵌顿性胆总管结石患者越趋常见。高龄患者常合并有不同程度的心脑血管、肺部及糖尿病等基础疾病,传统外科手术耐受性差,风险高,结石嵌顿于乳头是导致ERCP选择性胆管插管失败常见原因。运用Precut技术达到胆管深部插管及十二指肠乳头括约肌切开以解决胆管结石嵌顿,实现相关的治疗目的。现回顾性总结我院2007~2009年38例高龄患者运用Precu