双导丝插管技术及乳头括约肌预切开术在困难性胆管插管ERCP中的临床应用价值  

Clinical value of double guidewire technique and precut sphincterotomy for difficult biliary cannulation in ERCP

作　　者：陈培生[1] 刘素英[1] 邓三花[1] 詹梅香 孔伟芳 何锋坚[1] 徐胜浩 岳辉[1] 

机构地区：[1]南方医科大学第三附属医院消化内科,510630

出　　处：《现代消化及介入诊疗》2015年第2期103-105,共3页Modern Interventional Diagnosis and Treatment in Gastroenterology

摘　　要：目的评价双导丝插管技术和乳头括约肌预切开术在困难性胆管插管ERCP中的疗效和安全性。方法对2011年1月至2014年1月我院需要治疗性ERCP胆管插管的205例患者进行研究。对使用常规方法胆管插管的定义为常规组(205例),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(28例),而将常规插管不成功者即采用乳头括约肌预切开术后胆管插管的定义为预切开组(27例)。评价各组胆道插管的成功率及并发症的发生率。结果在整个研究期间内需要ERCP胆管插管患者205例,其中常规胆管插管成功150例,成功率为73.2%(150/205),而常规胆管插管失败的55人随机分为2组,分别应用双导丝插管(28例)以及乳头括约肌预切开后选择性胆管插管(27例),其中双导丝组成功率为85.7%(24/28),预切开组成功率为85.2%(23/27),最终有8例不能完成ERCP胆管插管,总成功率达96.1%(197/205),术后常规组中插管相关并发症共12例(占8.0%),双导丝组2例(占8.3%)、预切开组2例(占8.7%),三者互相比较差异无统计学意义(P>0.05)。结论在困难性胆管插管ERCP中常规胆管插管不成功者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,且后两者不增加ERCP的并发症的风险,是困难性胆管插管ERCP中可以选择的安全有效方法。Objective To evaluate the clinical value of double guidewire technique （DGT） and precut sphincterotomy （PST） in difficult biliary cannulation of ERCP. Methods We evaluated 205 cases by ERCP from January 2011 to January 2014. Fifty five cases were randomly allocated into DGT （n = 28） and PST （n = 27） groups when standard bile duct cannulation failed. The success rates of biliary cannulation and complications related to the procedure were recorded. Results A total of 205 cases were performed during the study period and the success rate was 73.2% via standard bile duct cannulation （SDC）. DGT or PST was further car- ried out in 55 patients, and successful cannulation rate in DGT and PST groups were 85.7% and 85.2%, respectively. The total success rate was 96.1%（197/205）. Complication rates in three groups did not differ significantly （SDC 8.0%, DGT 8.5%, PST 8.7%, P 〉 0.05）. Conclusion DGT and PST are effective and safe methods and can increase the success rate of difficult biliary cannulation in ERCP. DGT and PST do not increase the related complications of ERCP by experienced endoscopist.

关 键 词：双导丝插管 预切开技术 困难性插管 ERCP 

分 类 号：R532.205[医药卫生—内科学]