经胰管胆胰管隔膜切开术及双导丝术在困难性插管ERCP 中的应用及安全性分析

Endoscopic transpancreatic precut sphincterotomy and doubleguidewire technique in difficult bile duct cannulation during endoscopic retrograde cholangiopancreatography

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。

Abstract:

Objective To evaluate the applicability and security of transpancreatic precut sphincterotomy vs double guidewire technique for cannulation in difficult bile duct cannulation in endoscopic retrograde eholangiopancreatography (ERCP). Methods Retrospective analysis of 158 cases difficult bile duct cannulation in ERCP from January 2012 to January 2014, according to the intubation tube method, we divided all the cases into 3 groups, transpancreatic precut sphincterotomy group (group A); double guide wire technique group (group B); single guide wire technique group (group C). Then compare the intubation success rate and the incidence of complications among the 3 groups. Results 54 of 58 patients in group A intubation successful, the success rate is 93.1%, 50 of 56 patients in group B intubation successful, the success rate is 89.3%, 26 of 44 patients in group C intubation successful, the success rate is 59.1%, 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, 4 cases were complicated with acute pancreatitis, hemorrhage in 6 cases, infection in 2 cases, the complication rate is 20.7%; In group B, 5 cases were complicated with postoperative pancreatitis, 4 cases of infection, incidence of complications is 16.1%; 7 patients were complicated with pancreatitis in group C, hemorrhage in 2 cases, infection in 4 cases, complication rates is 29.5%, 3 groups were no perforation occurred.The complication rate of group B is lower than in group A, but no significant difference (P > 0.05), group A and group C, B and C complication rates had significant difference (P < 0.05). Conclusions When selective bile duct intubation is difficulty and guide wire thread into the pancreatic duct, continue to single guide wire have low intubation success rate and higher incidence of complications,transpancreatic precut sphincterotomy and double guide wire technique can effectively improve the success rate of intubation, and complication rates are relatively low, no significant difference between the two.