ERCP尽早经胰管括约肌预切开的安全性研究

发布时间：2018-04-22 02:00

本文选题：内镜逆行胰胆管造影术 + 经胰管　；参考：《青岛大学》2014年硕士论文

【摘要】：目的探讨ERCP时尽早经胰管括约肌预切开后胆管插管的安全性。方法前瞻性观察2011年10月至2013年8月在我院行ERCP治疗的患者,将112例符合入选标准的患者纳入研究。按1：3的比例随机分为两组：A组导丝首次进入胰管即行经胰管括约肌预切开；B组继续尝试常规胆管插管15min,15min内胆管插管成功者为B1组,15min胆管插管仍失败或导丝反复进入胰管5次时再行经胰管括约肌预切开者为B2组。统计各组胆管插管成功率、胆管插管时间、X线照射时间、并发症的发生率和术后急性胰腺炎相关的危险因素。结果A组所用胆管插管时间、X线照射时间均比B2组短,差异有统计学意义(7.9min与16.9min,5.8min与10.4min,P0.05)。A组与B2组的胆管插管成功率,无统计学差异,但B2组胰腺炎发生率明显高于A组(26.9%与3.4%,P=0.02)。多变量分析提示：插管时间10min、导丝进入胰管2次是术后急性胰腺炎的危险因素。结论对ERCP首次插管导丝进入胰管的患者尽早行经胰管括约肌预切开是安全的,有利于减少急性胰腺炎的发生率。
[Abstract]:Objective to investigate the safety of bile duct intubation after early transphincterotomy through pancreatic sphincter on ERCP. Methods from October 2011 to August 2013, 112 patients with ERCP were enrolled in the study. According to the 1:3 ratio, two groups were randomly divided into two groups: group 1: group A: first entering the pancreatic duct, group B continued to attempt routine bile duct intubation within 15 minutes or 15 minutes, the group B1 failed to intubate the duct at 15 minutes or the lead wire was repeatedly inserted into the pancreatic duct, and the group B continued to attempt the routine bile duct intubation within 15 minutes or 15 minutes after the successful intubation. Group B2 was treated with pre-incision of pancreatic sphincter after 5 times of pancreatic duct entry. The success rate of bile duct intubation, the time of bile duct intubation and X-ray irradiation time, the incidence of complications and the risk factors of postoperative acute pancreatitis were analyzed. Results the time of bile duct intubation in group A was shorter than that in group B2, and the difference was statistically significant (7.9min, 16.9min, 5.8min and 10.4min). There was no significant difference in the successful rate of bile duct intubation between group A and group B2, but the incidence of pancreatitis in group B2 was significantly higher than that in group A (26.9%) and group B (3.4P 0.02). Multivariate analysis showed that intubation time was 10 min and the lead wire entering the pancreatic duct twice was the risk factor of postoperative acute pancreatitis. Conclusion it is safe for the patients with ERCP first intubation to enter the pancreatic duct as early as possible through the pancreatic sphincter, which is helpful to reduce the incidence of acute pancreatitis.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R576

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