两种技术在ERCP选择性胆管插管困难时的对照研究  

Comparison between two ERCP techniques in difficult selective bile duct cannulation

作　　者：鲁临[1] 曾宪忠[1] 陈健[2] 赵清喜[3] 丰义宽[4] 姜开通[1] 吉布席[1] 黄传兰[1] 孔庆印[1] 鲁华荣[1] 

机构地区：[1]山东省临沂市人民医院消化内科,276003 [2]山东大学齐鲁医院消化科 [3]青岛大学附属医院消化科 [4]维坊市人民医院消化科

出　　处：《中华消化内镜杂志》2008年第2期73-76,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的比较两种插管方法在ERCP选择性胆管插管困难时的成功率和并发症发生率。方法将85例接受胆管ERCP治疗时反复插入胰管的选择性插管困难患者随机分成两组，胰管留置导丝组（A组）42例，采用胰管留置导丝技术，胰管预切开组（B组）43例，采用胰管预切开技术。记录两组的成功率、ERCP术后4h、24h血淀粉酶、ERCP术前及术后24h白血球计数、体温、腹痛以及ERCP术后胰腺炎发生率，并对两组进行比较。结果成功率：A组为85．7％（36／42），B组为88．4％（38／43）。ERCP术后胰腺炎发生率：A组4．8％（2／42），B组16．3％（7／43）例，差异有统计学意义。术后高淀粉酶血症发生率：A组7．1％（3／42），B组20．9％（9／43），差异有统计意义。腹痛发生率：A组11．9％（5／42），B组16．3％（7／43）。术后发热或血象升高发生率：A组4．8％（2／42），B组4．7％（2／43）。结论ERCP选择性胆管插管困难时采用胰管导丝留置法可有效提高成功率，减少并发症尤其是ERCP术后胰腺炎和高淀粉酶血症的发生率。Objective To compare the effectiveness of two techniques in difficult or failed selective bile duct cannulations and occurrence of post-ERCP complications. Methods Eighty-five cases of difficult selective bile duct cannulation in ERCP were randomly divided into two groups. Indwelling pancreatic duct gnidewires were used in group A （ n = 42 ）, while in group B （ n = 43 ） , pre-cut of pancreatic duct was performed. Such variables as rate of successful bile duct cannulation, post-ERCP blood amylase 4 and 24 hourly, occurence of pancreatitis, and count of white blood cell , temperature, abdominal pain before and after ERCP were compared between the two groups. Results In group A,the success rate of ERCP was 85.7% （36/42） , whereas that of group B was 88.4% （38/43）. There was significant difference in occurrence of post-ERCP pancreatitis between the two groups with 2 in group A and 7 in group B（P〈0.01）. There was also significant difference in occurrence of hyperamylasemia with 3 cases in group A （ 7.1% ） and 9 in group B （ 20.9% ） （ P 〈 0. 01 ）. The occurrences of abdominal pain were 11.9% （ 5/42 ） and 16. 3% （ 7/43 ） respectively. Two case of leukocytosis and/or fever occurred in both groups （ P 〉 0. 05 ）. There was no procedure-related mortality. Condusion In difficult or failed selective bile duet cannulation during ERCP, indwelling gnidewire method, more effective and safe, can reduce the rate of complications, especially post- ERCP pancreatitis and hyperamylasemia.

关 键 词：胰腺炎 高淀粉酶血症 内窥镜逆行胰胆管造影术 

分 类 号：R657[医药卫生—外科学] R57[医药卫生—临床医学]