摘要
目的探讨经胰管胆胰管隔膜切开术及双导丝术在困难性插管内镜逆行胰胆管造影术(ERCP)中的应用及安全性。方法回顾性分析2012年1月-2014年1月行ERCP插管时选择性胆管插管困难患者158例,根据插管方法分为经胰管胆胰管隔膜切开法(A组)、双导丝法(B组)和单导丝法(C组)3组。比较三种方法插管的成功率及并发症发生率。结果 58例A组患者插管成功54例,成功率93.1%,56例B组患者插管成功50例,成功率89.3%,44例C组患者插管成功26例,成功率59.1%,A和B组成功率差异无统计学意义(P>0.05),A与C组,B与C组差异均有统计学意义(P<0.05)。A组并发胰腺炎4例,出血6例,感染2例,并发症发生率20.7%;B组并发术后胰腺炎5例,感染4例,并发症发生率16.1%;C组并发胰腺炎7例,出血2例,感染4例,并发症发生率29.5%,3组均无穿孔发生。B组并发症发生率略低于A组,但无明显差异(P>0.05),A与C组,B与C组并发症发生率均差异有统计学意义(P<0.05)。结论选择性胆管插管困难而导丝进入胰管时,继续常规单导丝插管成功率低且并发症发生率较高,经胰管乳头括约肌预切开术与双导丝法均可有效提高插管成功率,且并发症发生率均相对较低,两者之间无明显差异。
Objective To evaluate the applicability and security of transpancreatic precut sphincterotomyvs double guidewire technique for cannulation in difficult bile duct cannulation in endoscopic retrogradeeholangiopancreatography(ERCP).Methods Retrospective analysis of158cases difficult bile duct cannulationin ERCP from January2012to January2014,according to the intubation tube method,we divided all the casesinto3groups,transpancreatic precut sphincterotomy group(group A);double guide wire technique group(groupB);single guide wire technique group(group C).Then compare the intubation success rate and the incidence ofcomplications among the3groups.Results54of58patients in group A intubation successful,the success rateis93.1%,50of56patients in group B intubation successful,the success rate is89.3%,26of44patients in groupC intubation successful,the success rate is59.1%,there was no significant difference between group A and B(P>0.05),group A and group C,group B and C have significant difference(P<0.05).In group A,4cases werecomplicated with acute pancreatitis,hemorrhage in6cases,infection in2cases,the complication rate is20.7%;Ingroup B,5cases were complicated with postoperative pancreatitis,4cases of infection,incidence of complicationsis16.1%;7patients were complicated with pancreatitis in group C,hemorrhage in2cases,infection in4cases,complication rates is29.5%,3groups were no perforation occurred.The complication rate of group B is lowerthan in group A,but no significant difference(P>0.05),group A and group C,B and C complication rates hadsignificant difference(P<0.05).Conclusions When selective bile duct intubation is difficulty and guide wirethread into the pancreatic duct,continue to single guide wire have low intubation success rate and higher incidenceof complications,transpancreatic precut sphincterotomy and double guide wire technique can effectively improve thesuccess rate of intubation,and complication rates are relatively low,no significant difference between the two.
作者
孙雄
龚镭
彭晓斌
唐学军
王小云
谈春晓
Xiong Sun;Lei Gong;Xiao-bin Peng;Xue-jun Tang;Xiao-yun Wang;Chun-xiao Tan(Department of Gastroenterology, Shanghai Putuo District People’s Hospital, Shanghai 200060, China;Department of Gastroenterology, Wuxi No. 2 People’s Hospital, Wuxi, Jiangsu 214002, China)
出处
《中国内镜杂志》
北大核心
2017年第8期47-50,共4页
China Journal of Endoscopy
关键词
内镜逆行胰胆管造影
经胰管乳头括约肌预切开
双导丝法
单导丝法
endoscopic retrograde cholangiopancreatography
transpancreatic precut sphincterotomy
double guide wire technique
single guide wire technique
