内镜下逆行胰胆管造影术尽早经胰管括约肌预切开的安全性  

Safety of early transpancreatic duct precut during endoscopic retrograde cholangiopancreatography

作　　者：葛祥丽 毛涛[1] 孙学国[1] 鞠辉[1] 江月萍[1] 赵清喜[1] 田字彬[1] 

机构地区：[1]青岛大学医学院附属医院消化科,山东省青岛市266003

出　　处：《世界华人消化杂志》2014年第8期1166-1170,共5页World Chinese Journal of Digestology

摘　　要：目的:探讨内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,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2011-10/2013-08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15 min,15 min内胆管插管成功者为B1组,15 min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(7.9 min vs 16.9min,5.8 min vs 10.4 min,P<0.05).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%vs 3.4%,P=0.02).多变量分析提示:插管时间>10 min、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.AIM： To explore the effectiveness and safety of early transpancreatic duct precut in achieving cannulation of the common bile duct. METHODS： One hundred and twelve patients who underwent endoscopic retrograde cholan- giopancreatography （ERCP） from October 2011 to August 2013 were randomly assigned into two groups （at a 1：3 ratio）. Group A underwent precut immediately after first cannulation with guide- wire sliding into the pancreatic duct, and group B underwent standard cannulation attempts for a total of 15 min. If successful cannulation of thecommon bile duct was achieved within this time and with the pancreatic duct inserted less than 5 times, patients were included in the subgroup B1; otherwise, a precut procedure was carried out, and the patients were included in the subgroup B2. The success rate of biliary cannulation, mean cannulation time, mean x-ray exposure time, procedure-related complication rate and risk fac- tors for post-ERCP pancreatitis were compared among the groups. RESULTS： The mean cannulation time and mean X-ray exposure time in group A were sig- nificantly lower than those in group B2 （7.9 min vs 16.9, 5.8 min vs 10.4 min, P 〈 0.05 for both）. There were no significant differences between the two groups in the cannulation rates, but the post-ERCP pancreatitis rate was higher in group B2 than in group A （26.9% vs 3.4%, P = 0.02）. Multivariate analysis indicated that risk factors for post-ERCP pancreatitis were more than 10 minutes of biliary cannulation attempts and more than 2 times of cannulation of the pancre- atic duct. CONCLUSION： Early transpancreatic duct pre- cut is safe and effective during ERCP.

关 键 词：内镜逆行胰胆管造影术 经胰管 预切开 

分 类 号：R657.4[医药卫生—外科学]