3种辅助插管技术在ERCP胆管插管困难病例中的临床应用  

Clinical application of three assisted catheterizations for difficult biliary cannulation

作　　者：袁帅[1] 孙大勇[2] 

机构地区：[1]南方医科大学附属小榄医院消化科,528415 [2]广州军区总医院消化科,510120

出　　处：《现代消化及介入诊疗》2013年第3期135-137,共3页Modern Interventional Diagnosis and Treatment in Gastroenterology

摘　　要：目的对比双导丝插管技术、针状刀乳头预切开术与经胰管乳头预切开术3种辅助插管技术在ERCP胆管插管困难病例中的成功率和并发症发生率,探讨安全有效的辅助插管技术。方法将104例经内镜逆行胰胆管造影(ERCP)选择性胆管插管困难患者随机分成3组分别行3种不同辅助插管技术,即双导丝插管术组(A组)35例,针状刀乳头预切开组(B组)35例,经胰管乳头预切开组(C组)34例。对比3组患者辅助胆管插管的成功率、获得成功插管的时间与并发症的发生率。结果 A组辅助插管成功率为51.43%(18/35),B组为91.43%(32/35),C组为70.59%(24/34),3组成功率差异均有统计学意义(P<0.05)。3组成功插管时间分别为(7.83±1.08)min,(8.20±0.91)min和(7.91±1.20)min,3组成功插管时间无显著性差异(P>0.05)。3组患者术后胰腺炎发生率分别为:2.86%(1/35),22.86%(8/35)与8.82%(3/34),3组间术后胰腺炎发生率差异有统计学意义(P<0.05)。3组患者均无严重感染、大出血、穿孔等并发症发生。结论 3种辅助插管技术均可提高胆管插管成功率,其中针状刀乳头预切开术与经胰管乳头预切开术有更高的成功率,但术后胰腺炎等并发症发生率亦较高;双导丝插管术成功率较低,但安全性较高。Objective To compare the effectiveness and post-ERCP complications of three assisted catheterizations in difficult biliary cannulation. Methods A total of 104 cases of difficult biliary cannulations in ERCP were randomly divided into three groups, and then separately received three kinds of assisted catheterizations. Group A received double-guide wire technique （n=35）, group B received needle-knife sphincterotomy （n=35）, and group C received pre-cut of pancreatic duct（n=34）. Comparisons for the success rate, procedure time and complications were performed among the three groups. Results The success rate of group B（91.43%, 32/35） was higher than that of group C（70.59%, 24/34）and group A（51.43%, 18/35）（P0.05）.The time of successful biliary cannulation in group A,B and C was （7.83 ± 1.08）minutes,（8.20 ± 0.91） minutes and（7.91 ± 1.20）minutes respectively, there was no significant difference among the there groups（P0.05）.With regard to the incidence of post-ERCP pancreatitis, group B（22.86%, 8/35）was much higher than group C（8.82%, 3/34）and group A （2.86%,1/35）（P0.05）. There were no serious complications such as infection, hemorrhage or perforation in either group. Conclusion All of the three assisted catheterizations could increase the success rate of biliary cannulation, needle-knife sphincterotomy and pre-cut of pancreatic duct could gain higher success rate with more post-ERCP complications, while double-guide wire technique, though with a lower success rate, was much safer.

关 键 词：内窥镜逆行胰胆管造影术 困难胆管插管 辅助插管技术 并发症 

分 类 号：R656.640.4[医药卫生—外科学]