ERCP选择性胆管插管困难原因分析及对策研究进展

发布时间：2018-11-13 07:57

【摘要】：背景:内镜逆行胰胆管造影术(ERCP)多应用于胆胰疾病的诊治,且临床效果良好。选择性胆管插管的成功是ERCP进一步诊治胆道疾病的基础。如何提高胆管插管的成功率,仍是内镜医师最关注的焦点。目的:通过综述分析ERCP选择性胆管插管困难原因及提高胆管插管成功率的对策,从而为ERCP过程中成功胆管插管提供一些参考。方法:以“选择性胆管插管困难原因,困难性插管,乳头预切开术,胰管占据法”等关键词进行检索,找出提高胆管插管成功率的研究,并对各种方法选择时机及可能出现的并发症作出总结。结果与结论:目前有大量文献报道选择性胆管插管困难原因及如何提高胆管插管的成功率,综合研究结果表明,选择性胆管插管困难原因有:患者本身的病理或解剖因素、操作内镜医师的水平、器械原因;预切开术应用于无法进入乳头者,胰管占据法应用于反复进入胰管者,择期行二次ERCP应用于行预切开后仍无法成功胆管插管者,会师技术应用于ERCP失败的胆道梗阻患者。
[Abstract]:Background: endoscopic retrograde cholangiopancreatography (ERCP) is widely used in the diagnosis and treatment of biliary and pancreatic diseases. The success of selective bile duct intubation is the basis of ERCP in the diagnosis and treatment of biliary diseases. How to improve the success rate of bile duct intubation is still the focus of endoscopic physicians. Objective: to summarize and analyze the causes of ERCP selective bile duct intubation and the countermeasures to improve the success rate of bile duct intubation so as to provide some references for successful bile duct intubation in the process of ERCP. Methods: the key words of "selective bile duct intubation difficulty, difficult intubation, papillectomy and pancreatic duct occupation" were used to find out how to improve the success rate of bile duct intubation. The timing and possible complications of various methods were summarized. Results and conclusion: there are a large number of reports on the causes of selective bile duct intubation and how to improve the success rate of selective bile duct intubation. The comprehensive results show that the causes of selective bile duct intubation difficulties are the pathological or anatomical factors of the patients themselves. The level of endoscopic surgeon and the cause of the instrument; Pre-incision was applied to those who could not enter the papilla, pancreatic duct occupation method was applied to those who repeatedly entered the pancreatic duct, selective secondary ERCP was applied to those who could not successfully intubate the bile duct after pre-incision, and the technique of association was applied to the patients with biliary tract obstruction who had failed in ERCP.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.4

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