双导丝技术与早期乳头括约肌预切开术在困难ERCP中疗效分析  

The curative effect of double guide wire and early nipple sphincter pre-incision techniques in difficult ERCP

作　　者：杨春建[1] 齐伟[1] 钱小星[1] 文卫 YANG Chun-jian;QI Wei;QIAN Xiao-xing(The Hefei Hospital of Anhui Medical University,Hefei 230011,China))

机构地区：[1]安徽医科大学附属合肥医院肝胆外科,合肥230011

出　　处：《肝胆外科杂志》2018年第6期430-432,共3页Journal of Hepatobiliary Surgery

摘　　要：目的探讨双导丝技术与早期乳头预切开技术在困难性ERCP插管中的有效性和安全性。方法对2015年3月至2017年8月对106例困难ERCP患者所采用的两种方法进行对比研究。对常规插管反复进入胰管者采用双导丝插管技术胆管插管的定义为双导丝组(46例),而将常规插管不成功者即早期行乳头括约肌预切开术后胆管插管的定义为早期预切开组(60例)。观察两组插管的成功率、术后胰腺炎、出血、穿孔等并发症的发生率。结果在整个研究期间内106例困难ERCP患者,分别应用双导丝插管(46例)以及早期乳头括约肌预切开后选择性胆管插管(60例),其中双导丝组成功率为93.5%(43/46),早期预切开组成功率为96. 7%(58/60),术后胰腺炎发生率,双导丝组25例(占54. 3%)、早期预切开组13例(占21. 6%),两组比较差异性有统计学意义(P <0. 05);无一例患者出现穿孔、出血。结论在困难性胆管插管ERCP中采用双导丝插管技术或者乳头括约肌预切开术均能提高插管成功率,早期预切开技术ERCP术后胰腺炎的发生率较双导丝组明显降低,可作为困难ERCP插管中的补充方式。Objective To investigate the effectiveness and safety of double guide wire technology and early nipple sphincter pre-incision technique in difficult ERCP.Method A comparative study was conducted on the two methods used in 106 difficult ERCP patients from March 2015 to August 2017.For the conventional intubation,the double guide wire intubation is defined as the double guide wire group(46 cases),the early stage of the pre-incision of the nipple sphincter is defined as the early pre-incision group(60 cases).The success rate of two groups of intubation,postoperative pancreatitis,hemorrhage,perforation and other complications were observed.Results The 106 patients with difficulty ERCP during the entire study period,double guide wire intubation (46 cases),Selective bile duct intubation after pre-incision of early nipple sphincter (60 cases),The success rate of double guide wire group is 93.5 % (43/46),the early pre-incision group is 96.7%(58/60),the incidence of postoperative pancreatitis,double guide wire group was 25 cases (54.3%),early pre-incision group was 13 cases (21.6%)o The differences between the two groups were statistically significant(P <0.05 ).No patient had perforation or bleeding.Conclusion Adopt double guide wire intubation technology or nipple sphincter pre-incision in the difficult bile duct intubation ERCP can improve the success rate of intubation.The incidence of postoperative pancreatitis after early pre-incision technique was significantly lower than that in the double guide wire group,which can be used as a supplementary method in difficult ERCP.

关 键 词：双导丝插管 早期预切开技术 困难性插管 ERCP 

分 类 号：R657.4[医药卫生—外科学]