经胆总管十二指肠瘘胆管插管行治疗性ERCP的安全性和有效性研究  

Safety and effectiveness of choledochoduodenal fistula biliary intubation in treatment of therapeutic ERCP

作　　者：王飞[1] 陈珊杰 缪林[1] WANG Fei;CHEN Shanjie;MIAO Lin(Digestive Medical Center,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China;Jiangbei Hospital,Jiangsu Traditional Chinese Medicine Hospital,Liuhe District Hospital of Traditional Chinese Medicine,Nanjing 211500,China)

机构地区：[1]南京医科大学第二附属医院消化医学中心,江苏南京210011 [2]江苏省中医院江北院区(南京市六合区中医院),江苏南京211500

出　　处：《中国医药科学》2019年第24期219-222,共4页China Medicine And Pharmacy

摘　　要：目的探讨经胆总管十二指肠瘘(CDF)胆管插管行治疗性ERCP的安全性和有效性,并指导临床工作。方法回顾性分析自2014年1月~2018年12月期间,在本院消化医学中心行ERCP术中发现CDF,并经CDF胆管插管行治疗性ERCP的患者共84例,分析患者基本资料,记录ERCP操作过程,观察ERCP术后并发症。结果本研究84例患者中,所有CDF均位于十二指肠乳头上方,其中圆孔状37例,裂隙状15例,点状26例,扁平状6例,平均瘘口直径为0.31±0.19cm。所有患者均经CDF插管至胆管,胆管插管成功率为100%,治疗性ERCP成功率92.9%。其中行瘘口切开术17例,行瘘口气囊扩张术35例。ERCP术后胰腺炎发生率4.8%,胆管炎发生率2.4%,术后迟发性出血发生率1.2%,均通过保守治疗后好转。结论经CDF胆管插管行治疗性ERCP是安全和有效的,且可能降低ERCP术后胰腺炎发生率。Objective To investigate the safety and effectiveness of choledochoduodenal fistula(CDF)biliary intubation in treatment of therapeutic endoscopic retrograde cholangiopancreatography(ERCP),and to guide the clinical work.Methods A total of 84 patients diagnosed with CDF during ERCP in Digestive Medical Center,the Second Affiliated Hospital of Nanjing Medical University between January 2014 and December 2018 and treated through choledochoduodenal fistula(CDF)biliary intubation were retrospectively analyzed.The basic data of the patients were analyzed,the operation process of ERCP was recorded,and the postoperative complications of ERCP were observed.Results In 84 patients,all CDF were located above the duodenal papilla,including 37 cases of round hole,15 cases of slit,26 cases of dot,6 cases of flat,with an average fistula diameter of(0.31±0.19)cm.All patients were intubated to bile duct by CDF,the success rate of bile duct intubation was 100%,and the success rate of therapeutic ERCP was 92.9%.Among them,17 cases underwent fistulotomy and 35 cases underwent balloon dilatation.The incidence of pancreatitis,cholangitis and delayed bleeding after ERCP were 4.8%,2.4%and 1.2%respectively.Conclusion It is safe and effective to intubate therapeutic ERCP through CDF bile duct,and it may reduce the incidence of pancreatitis after ERCP.

关 键 词：胆总管十二指肠瘘 胆管插管 治疗性ERCP 安全性 有效性 

分 类 号：R576[医药卫生—消化系统]