双导丝技术及经胰管乳头预切开术在困难性ERCP胆管插管中的应用  

Application of double-guidewire technique and transpancreatic precut sphincterotomy in difficult biliary cannulation in ERCP

作　　者：徐兆军[1] 高波[1] 高敏[1] 戴雪松[1] 张振玉[1] XU Zhaojun;GAO Bo;GAO Min;DAI Xuesong;ZHANG Zhenyu(Department of Gastroenterology,the Affiliated Nanjing Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学附属南京医院消化科

出　　处：《胃肠病学和肝病学杂志》2019年第7期807-810,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的探讨双导丝技术及经胰管乳头预切开术在困难性经内镜逆行胰胆管造影(ERCP)胆管插管中的应用。方法选取2015年1月至2018年1月在我院消化内镜中心收治的困难性ERCP胆管插管患者81例,分三组采用不同插管方法,其中双导丝技术(A组)33例,经胰管乳头预切开术(B组)18例,常规插管法(C组)30例。比较3种方法胆管插管成功率及并发症发生率。结果A组患者28例插管进入胆总管,成功率84.8%,B组患者17例进入胆总管,成功率94.4%,C组患者16例进入胆总管,成功率53.3%。A、B两组插管成功率比较,差异无统计学意义(P>0.05),A、C两组,B、C两组插管成功率比较,差异有统计学意义(P<0.05),A组患者术后并发高淀粉酶血症4例,胰腺炎1例,无出血、穿孔,并发症发生率15.2%;B组患者术后并发高淀粉酶血症3例,消化道出血1例,急性胰腺炎1例,无穿孔患者,并发症发生率27.8%;C组患者术后并发高淀粉酶血症5例,胰腺炎1例,无出血、穿孔患者,并发症发生率20.0%。A、B、C三组并发症发生率差异无统计学意义(P>0.05)。结论ERCP选择性胆管插管困难,反复进入胰管,采用双导丝技术或经胰管乳头预切开术可明显提高插管成功率,且并发症无明显增加。Objective To investigate the application of double-guidewire technique and transpancreatic precut sphincterotomy in patients with difficult biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP). Methods Eighty- one cases with difficult biliary cannulation in ERCP were collected from Jan.2015 to Jan.2018.According to the cannulation method,they were divided into 3 groups,33 cases in double-guidewire technique group (group A),18 cases in transpancreatic precut sphincterotomy group (group B),and 30 cases in conventional cannulation technique group (group C).The success rates of cannulation and incidence rate of postoperative complications among the three groups were compared. Results The success rate of cannulation was 84.8%(28/33) in group A,94.4%(17/18) in group B,and 53.3%(16/30) in group C.There was no significant difference between group A and group B ( P >0.05 ),and significant differences could be found in group A and group C,group B and group C ( P < 0.05 ).In group A,4 cases were complicated with hyperamylasemia,1 case with acute pancreatitis,no bleeding or perforation,the incidence rate of complications was 15.2%.In group B,3 cases were complicated with hyperamylasemia,1 case with gastrointestinal bleeding,1 case with acute pancreatitis,no perforation,the incidence rate of complications was 27.8%.In group C,5 cases were complicated with hyperamylasemia,1 case with pancreatitis,no bleeding or perforation,the incidence rate of complications was 20.0%.There was no significant differences among three groups ( P >0.05). Conclusion When guidewire gets into the pancreative duct repeatedly in difficult biliary cannulation in ERCP,double-guidewire technique or transpancreatic precut sphincterotomy can be applied to improve the success rate of cannulation effectively,with no obvious increase in the incidence of complications.

关 键 词：经内镜逆行胰胆管造影 双导丝技术 经胰管乳头预切开术 

分 类 号：R57[医药卫生—消化系统]