经胰管胆胰管隔膜预切开术留置导丝法和胰管支架法在困难性经内镜逆行胰胆管造影中的应用  

Application of transpancreatic septotomy with pancreatic duct stent or guide wire as precutting technique in difficult endoscopic retrograde cholangiopancreatography

作　　者：仲恒高[1] 缪林[1] 季国忠[1] 蒋国斌[1] 杨丽华[1] 刘政[1] 范志宁[2] 

机构地区：[1]南京医科大学第二附属医院消化医学中心暨南京医科大学消化内镜研究所,南京210011 [2]江苏省人民医院内镜中心,南京210029

出　　处：《临床肝胆病杂志》2015年第12期2070-2072,共3页Journal of Clinical Hepatology

摘　　要：目的探讨经胰管胆胰管隔膜预切开术留置导丝法和胰管支架法在困难性经内镜逆行胰胆管造影（ERCP）胆管插管中的应用价值。方法收集2012年6月-2014年5月南京医科大学第二附属医院消化医学中心困难性ERCP患者309例。其中228例放入胰管导丝或胰管塑料支架,或常规乳头预切开,胆管插管成功;剩余81例,行经胰管胆胰管隔膜预切开留置导丝术（导丝组,37例）和胰管胆胰管隔膜预切开留置胰管支架术（支架组,44例）,比较两种方法插管成功率及并发症发生率。结果 81例患者中77例成功插入胆管,导丝组成功率91.89%（34/37）,支架组97.73%（43/44）,两组比较差异无统计学意义（P〉0.05）。81例患者中17例出现并发症,其中,导丝组急性胰腺炎8例,出血3例,胆道感染1例;支架组急性胰腺炎3例,出血1例,胆道感染1例。两组比较,支架组总并发症发生率低于导丝组（11.36%vs 32.43%）,差异有统计学意义（χ^2=3.75,P〈0.05）。其中急性胰腺炎的发生率支架组低于导丝组（6.82%vs 21.62%）,差异有统计学意义（χ^2=2.25,P〈0.05）。结论经胰管胆胰管隔膜预切开术可进一步提高ERCP胆管插管成功率,其中支架法较导丝法具有更高的胆管插管成功率,前者ERCP术后胰腺炎发生率更低,更安全。Objective To investigate the application value of transpancreatic septotomy with pancreatic duct stent or guide wire in difficult endoscopic retrograde cholangiopancreatography（ ERCP）. Methods A total of 309 patients who underwent difficult ERCP in Medical Center for Digestive Diseases,The Second Affiliated Hospital of Nanjing Medical University from June 2012 to May 2014 were selected; 228 patients among them received placement of pancreatic duct guide wire / plastic stent or conventional precut papillotomy,and achieved successful bile duct cannulation; the other 81 patients received transpancreatic septotomy with placement of guide wire（ guide wire group,37 patients）or pancreatic duct stent（ stent group,44 patients）. The success rate and incidence of complications were compared between these two methods for cannulation. Results Of the 81 patients who underwent transpancreatic septotomy,77 achieved successful bile duct cannulation,and the success rate did not differ significantly between the guide wire group and stent group（ 91. 89%（ 34 /37） vs 97. 73%（ 43 /44）; P〈0. 05）. Seventeen patients experienced complications,with 8 cases of acute pancreatitis,3 cases of hemorrhage,and 1 case of biliary tract infection in the guide wire group,and 3 cases of acute pancreatitis,1 case of hemorrhage,1 case of biliary tract infection in the stent group;compared with the guide wire group,the stent group had a significantly lower incidence of complications（ 11. 36% vs 32. 43%; χ^2= 3. 75,P〈0. 05） and a significantly lower incidence of acute pancreatitis（ 6. 82% vs 21. 62%; χ^2= 2. 25,P〈0. 05）. Conclusion Transpancreatic septotomy can further improve the success rate of bile duct cannulation with ERCP. The stent group has a higher success rate and a lower incidence of pancreatitis after ERCP than the guide wire group,and thus the application of stent is safer in clinical practice.

关 键 词：胆道疾病 胰腺疾病 胰胆管造影术 内窥镜逆行 手术后并发症 

分 类 号：R656[医药卫生—外科学]