胰管支架植入后针状刀乳头括约肌预切开术在困难内镜下逆行胰胆管造影中的应用  

Clinical application of post-pancreatic-stent-placement papillotomy by needle-knife precut in difficult biliary cannulation

作　　者：黄锦[1] 宋汉明[1] 沈颖洲[1] 方清流[1] 范志宁[2] 文卫[2] 王翔[2] 仲恒高[2] 熊观瀛[2] 

机构地区：[1]安徽省马鞍山市人民医院消化内镜中心,安徽马鞍山243000 [2]南京医科大学第二附属医院消化医学中心,江苏南京210012

出　　处：《中国内镜杂志》2012年第5期473-476,共4页China Journal of Endoscopy

摘　　要：目的探讨胰管支架植入后针状刀乳头括约肌预切开术在困难内镜下逆行胰胆管造影插管中的应用价值。方法 2008年10月～2011年9月在安徽省马鞍山市人民医院消化内镜中心和南京医科大学第二附属医院消化医学中心共199例行针状刀乳头括约肌预切开术患者符合研究条件,分为A、B两组,A组直接采用针状刀乳头括约肌预切开术,共143例患者;B组采用胰管支架植入后针状刀乳头括约肌预切开术,共56例患者。比较两组患者胆管插管成功率及术后并发症发生率。结果 A、B组胆管插管成功率分别为:87.4%(125/143)、96.4%(54/56)。两组患者并发出血比率分别为:10.5%(15/143)、1.8%(1/56);胆管炎发生率分别为:5.6%(8/143)、5.3%(3/56);术后胰腺炎发生率分别为:13.3%(19/143)、3.6%(2/56);两组均无穿孔或死亡病例。组间比较,B组插管成功率明显高于A组(P<0.05),两组患者胆管炎发生率无明显差异(P>0.05),但B组出血及术后胰腺炎发生率低于A组(P<0.05)。结论胰管支架植入后针状刀乳头括约肌预切开术可以提高困难ERCP的胆管插管成功率、降低针状刀乳头括约肌预切开术的并发症发生率。[ Objective ] To evaluate the clinical application of post-pancreatic-stent-placement papillotomy by needle-knife preeut in difficult biliary eannulation. [ Methods] From October 2008-September 2011, in the gas- trointestinal endoscopic centers of the Second Affiliated Hospital of Nanjing Medical University and the People＇s Hospital of Ma Anshan City, total of 199 patients underwent papillotomy by needle-knife precut in difficult biliary eannulation, of which 143 in group A directly implemented papillotomy by needle-knife precut and 56 in group B received post-panereatic-stent-placement papillotomy. The success rate of biliary eannulation and the incidence of complications in two groups were observed. [ Results ] The success rate of biliary cannulation in group A and B was 87.4% （125/143） and 96.4% （54/56） respectively; The incidence of bleeding was 10.5%（15/143）and 1.8% （1/56）, cholangeitis was 5.6% （8/143） and 5.3% （3/56）, post-ERCP pancreatitis was 13.3% （19/143） and 3.6% （2/56） respectively in the two groups. Compared with group A, the success rate of biliary cannulation in group B was higher. There were no significant difference between incidence of cholangitis in group A and B. However, the incidence of bleeding and post-ERCP pancreatitis in group B was lower than in group A. There was no perforation or death case in the two groups. [ Conclusion] It is suggested that post-pancreatic-stem-placement papillotomy by needle-knife precut may increase the success rate of biliary cannulation and decrease the incidence of complications caused by needle-knife precut in difficult ERCP procedures.

关 键 词：乳头括约肌切开术 胰管支架植入 困难ERCP 插管 并发症 

分 类 号：R576[医药卫生—消化系统]