经胰管胆胰管隔膜切开术及双导丝术在困难性插管ERCP中的应用及安全性分析

发布时间：2018-03-30 06:29

本文选题：内镜逆行胰胆管造影　切入点：经胰管乳头括约肌预切开　出处：《中国内镜杂志》2017年08期

【摘要】：目的探讨经胰管胆胰管隔膜切开术及双导丝术在困难性插管内镜逆行胰胆管造影术(ERCP)中的应用及安全性。方法回顾性分析2012年1月-2014年1月行ERCP插管时选择性胆管插管困难患者158例,根据插管方法分为经胰管胆胰管隔膜切开法(A组)、双导丝法(B组)和单导丝法(C组)3组。比较三种方法插管的成功率及并发症发生率。结果 58例A组患者插管成功54例,成功率93.1%,56例B组患者插管成功50例,成功率89.3%,44例C组患者插管成功26例,成功率59.1%,A和B组成功率差异无统计学意义(P0.05),A与C组,B与C组差异均有统计学意义(P0.05)。A组并发胰腺炎4例,出血6例,感染2例,并发症发生率20.7%;B组并发术后胰腺炎5例,感染4例,并发症发生率16.1%;C组并发胰腺炎7例,出血2例,感染4例,并发症发生率29.5%,3组均无穿孔发生。B组并发症发生率略低于A组,但无明显差异(P0.05),A与C组,B与C组并发症发生率均差异有统计学意义(P0.05)。结论选择性胆管插管困难而导丝进入胰管时,继续常规单导丝插管成功率低且并发症发生率较高,经胰管乳头括约肌预切开术与双导丝法均可有效提高插管成功率,且并发症发生率均相对较低,两者之间无明显差异。
[Abstract]:Objective to investigate the application and safety of transhepatic cholangiopancreatotomy and double wire guide in endoscopic retrograde cholangiopancreatography (ERCP) with difficult intubation. Methods the selective bile duct during ERCP intubation from January 2012 to January 2014 was retrospectively analyzed. 158 patients with difficult intubation, According to the method of intubation, the patients were divided into three groups: group A, group A, group B, group B, respectively. The success rate and the incidence of complications of the three methods were compared between group A and group C. results there were 54 cases of successful intubation in group A. The success rate was 93.1% in 56 patients in group B, 50 cases in group B, and 26 cases in group C with a success rate of 89.3%. There was no significant difference in success rate between group A and group B (P 0.05) and group C (P 0.05). 4 cases of pancreatitis were complicated with pancreatitis in group A (P 0.05) and group C (n = 4). There were 6 cases of hemorrhage, 2 cases of infection, 5 cases of postoperative pancreatitis, 4 cases of infection, 7 cases of complicated pancreatitis, 2 cases of hemorrhage and 4 cases of infection. The incidence of complications in group B was slightly lower than that in group A, and the incidence of complications in group B was slightly lower than that in group A. But there was no significant difference in the incidence of complications between group A and group C (P 0.05). Conclusion when selective bile duct intubation is difficult and lead wire enters the pancreatic duct, the success rate of continuous routine single-wire intubation is low and the incidence of complications is higher. The successful rate of intubation could be increased effectively by pre-operation of pancreatic duct papillary sphincter and double guide wire, and the incidence of complications was relatively low, and there was no significant difference between the two.
【作者单位】：上海市普陀区人民医院消化内科;江苏省无锡市第二人民医院消化内科;
【分类号】：R657.4

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