双导丝法在内镜下逆行性胰胆管造影术胆总管深插管中的临床研究  

Clinical research of double-guidewire technique in deep cannulation of bile duct in endoscopic retrograde cholangiopancreatography patients

作　　者：陈学清[1] 卢俊勇[1] 陈光春 文辉清 钟亮玉[1] 吴培虹[1] 詹红[1] 吴静[1] 

机构地区：[1]广州医学院第一附属医院消化内科,510182 [2]海印微创外科中心

出　　处：《中华生物医学工程杂志》2010年第3期235-237,共3页Chinese Journal of Biomedical Engineering

摘　　要：目的研究双导丝（DTG）法在胆总管深插管中的应用情况。方法选择89例患者，诊断为壶腹部肿瘤的患者被剔除。在行逆行性胰胆管造影术（ERCP）时，先用常规导丝引导切开刀或导管选择性胆总管插管。如导丝3次进入胰管后，则保留胰管导丝，重新从活检钳道插入第2根导丝进行选择性胆总管插管。根据导丝的走行及切开刀或导管抽吸胆汁证实选择性胆总管插管成功。双导丝插管难度评价标准：第2根导丝在1～3次内成功进入胆总管为容易；4—6次内成功为中等难度；7—10次以内成功为难度；如果10次内插管不成功为插管失败。并比较双导丝插管方法或常规插管方法ERCP术后胰腺炎的发生率。结果89例患者中，常规插管方法进行胆总管深插管的成功率约为67．4％（60／89）。5例患者（5．6％，5／89）导丝不能进入胆总或者胰管，其余24例（27．0％，24／89）采用DGT法。在DGT法插管中，13例（54．2％，13／24）为容易DGT插管，6例（25．0％，6／24）为中等难度DGT插管，4例（16．7％，4／24）为难度的DGT插管，只有1例（4．1％，1／24）患者虽然经过调整角度导丝仍然进入胰管而改用PSP法。在常规方法进行胆总深插管的患者中，4例（6．7％，4／60）例患者有术后胰腺炎，而DGT法中有2例（8．7％，2／23），两组间差异无统计学意义（P〉0．05）。结论在ERCP的操作中，DGT法是常规胆总管深插管失败后比较可靠的一种选择胆总管深插管方法。DGT法不会提高术后胰腺炎的发生率，容易掌握，可推荐作为ERCP术常规插管方法。Objective To evaluate the application of double guidewire technique （DGT） in deep cannulation of bile duct. Methods Eighty-nine patients were enrolled, patients diagnosed with ampullary tumors were excluded from this research. During endoscopic retrograde cholangiopancreatography （ERCP） , patients underwent knife or catheter selective cannulation of bile duct guided by routine guidewire. Pancreatic duct guidewire was retained and a second guidewire was inserted through biopsy foreep canal if the guidewire unintendedly entered pancreatic duct for 3 times. Selective cannulation of the common bile duet was verified to be successfully performed according to the course of guidewire and bile aspiration with knife or catheter. The difficulty of DGT was assessed by number of attempts before successful bile duct cannulation with the second guidewire and rated as follows： easy = one to three attempts; moderately difficult = four to six attempts; difficult = seven to ten attempts; failure -- more than 10 attempts but still unsuccessful. Incidences of post-ERCP pancreatitis by DGT and routine cannulation were compared. Results The success rate of deep cannulation of bile duct in routine ERCP procedures was 67.4% （60/89）, and the guidewires could not be inserted into bile duct or pancreatic duct in 5 patients （5.6%, 5/89）. Twenty-four patients （27.0%, 24/89） underwent DGT. In the DGT patients, eannulation was easy in 13 patients （54.2% , 3/24） , moderately difficult in 6 （25.0%, 6/24）, and difficult in 4 （16.7%, 4/24）, respectively. Only one patient （4.1%, 1/24） was converted to PSP since the guidewire constantly entered pancreatic duct despite angle adjustment. Postoperative pancreatitis was observed in 4 routine ERCP procedure cases （6.7%, 4/60） and 2 DGT cases （8.7% , 2/23） , and there was no significant difference between the two groups （P〉0.05）. Conclusions DGT appears to be a reliable method for selective deep bile duct eannulation after failed routine catheterization

关 键 词：胰胆管造影术 内窥镜逆行 手术后并发症 胰腺炎 胆总管插管 双导管法 

分 类 号：R576[医药卫生—消化系统]