三种预切开方式在插管困难的ERCP中的应用

发布时间：2018-03-06 02:08

本文选题：内镜逆行胰胆管造影　切入点：困难插管　出处：《重庆医科大学学报》2017年03期 　论文类型：期刊论文

【摘要】：目的:评价经内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)常规插管困难时,采用双导丝法(double guide-wire technique,DGT)、经胰管乳头括约肌预切开术(transpancreatic precut sphincterotomy,TPS)、针状刀乳头括约肌预切开术(needle-knife papillotomy,NKP)3种技术的成功率及并发症发生情况,初步探讨困难插管时3种方法的有效性及安全性。方法:对2003年8月至2016年3月的3 421例经ERCP治疗的病历资料进行回顾性分析,其中3 103例需行选择性胆管插管,常规选择性胆管插管顺利者为常规插管组(standard cannulation technique,SCT),共2 830例,273例常规胆管插管困难,其中DGT共87例,TPS共92例,NKP共94例。观察3组手术方式的操作时间、成功率及并发症发生率,并与常规插管进行比较。结果:SCT组与3种辅助插管(DGT、TPS、NKP)组的成功率分别为91.20%、96.55%、96.74%、97.87%,3种辅助插管成功率更高(P0.05);在选择性困难插管时3种辅助插管操作时间分别为(5.89±2.03)、(5.60±2.37)、(5.76±2.50)min,较SCT组有统计学差异[(6.40±2.91)min,P0.05];3种辅助插管高淀粉酶血症(hyperamylasaemia,PEHA)发生率分别为63.10%、41.56%、43.48%,均高于常规操作组(29.33%,P0.05),且DGT组高于TPS及NKP组(P0.05);ERCP术后胰腺炎(post-ERCP pancreatitis,PEP)在SCT、DGT、TPS、NKP 4组中的发生率分别为4.50%、9.52%、5.62%、4.35%,辅助插管3组间比较无统计学差异(P0.05),DGT组高于SCT组,但无统计学意义(P0.05);穿孔及出血发生率NKP分别为2.17%、6.52%,均显著高于SCT组(0.11%、0.18%,P0.05),且出血率较DGT(0%)及TPS组(0%)更高(P0.05),4组均无死亡病例。结论:3种辅助插管法在困难插管时可提高手术成功率及缩短手术时间。其中DGT组PEHA发生率较高,NKP组出血及穿孔风险较高。3组均未增加PEP发生,在选择性困难插管时3种手术方法可能是安全、有效的。
[Abstract]:Objective: to evaluate the difficulty of endoscopic retrograde cholangiopancreatography (ERCP) in the routine intubation of cholangiopancreatic cholangiopancreatography (ERCP) by endoscopic retrograde cholangiopancreatography. The success rate and complications of double guide-wire technique (DGTT), transphincterotomy (TPS) and needle-knife sphincterotomytomy (TPS) were studied. Methods: the clinical data of 3 421 patients treated with ERCP from August 2003 to March 2016 were analyzed retrospectively, 3 103 of them needed selective bile duct intubation. The routine selective bile duct intubation was performed successfully in the routine cannulation technique group (n = 2 830 cases), including 87 cases of DGT (n = 92) and 94 cases (n = 94). The operative time, success rate and complication rate of the three groups were observed. Results compared with routine intubation, the success rates of the two groups were 91.209.55 and 96.747.877.877.The operative time of the three kinds of intubation in selective difficult intubation was 5.89 卤2.035.60 卤2.37t 5.76 卤2.50 min, respectively, which was higher than that in the SCT group (P < 0.05), which was significantly higher than that in the SCT group (P < 0.05), which was significantly higher than that in the SCT group (P < 0.05), which was significantly higher than that in the SCT group (P < 0.05), which was higher than that in the SCT group (5.89 卤2.03g / min vs 5.76 卤2.50 min). Statistical difference [6.40 卤2.91 min] the incidence of hyperamylasemiaemia and hyperamylasaemiafida PEHAA were 63.1010, 41.56 and 43.48, respectively, which were higher than those of routine operation group (29.33%, P 0.05), and that of DGT group was higher than that of TPS group and NKP group (P 0.05). The incidence of post-ERCP creatitis-PEP in SCTD GTV / TPSNK4 group was 4.500.9.52% and 5.62%, 4.35% respectively. There was no statistical difference between the two groups. P0.05DGT group was higher than SCT group. The incidence of perforation and hemorrhage was 2.17 and 6.52, respectively, which was significantly higher than that in SCT group (0.110.18), and the bleeding rate was higher than that in DGT0 and TPS groups. Conclusion all of the three auxiliary intubation methods can improve the operation when intubation is difficult. The incidence of PEHA in DGT group was higher than that in NKP group and the risk of hemorrhage and perforation was higher in group 3. The incidence of PEP was not increased in DGT group. The three surgical procedures may be safe and effective when selective intubation is difficult.
【作者单位】：重庆医科大学附属第一医院第一分院消化内科;重庆医科大学附属第一医院消化内科;
【分类号】：R656

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