导丝进入胰管的困难性胆管插管策略在内镜逆行胰胆管造影术中的应用

Strategy of difficult selective biliary cannulation for patients having unintentional pancreaticduct cannulation during ERCP

摘要:

目的 探讨导丝进入胰管的困难性胆管插管策略应用于内镜逆行胰胆管造影术（ERCP）中的临床效果。方法 回顾性分析该院63例导丝进入胰管的困难性胆管插管患者的临床资料。依次采用双导丝法、胰管预切开法和胰管支架法选择性胆管插管，根据不同胆管插管方法分为双导丝组、胰管预切开组和胰管支架组。分析各组的插管成功率、插管时间及ERCP术后并发症之间的差异。结果 3组总体插管成功率为96.8%。双导丝组、胰管预切开组及胰管支架组的插管时间分别为（70.7±28.6）、（116.6±43.2）和（129.1±88.2）s，组间比较，差异有统计学意义（P < 0.05）。ERCP术后高淀粉酶血症总体发生率为39.3%，胰管预切开组明显高于其他两组（P < 0.05）。ERCP术后胰腺炎（PEP）总发生率为21.3%，胰管预切开组明显高于其他两组（P < 0.05）。ERCP出血发生率为6.6%。未发生重症胰腺炎和十二指肠穿孔病例。结论 导丝进入胰管后依次采用双导丝法、胰管预切开法和胰管支架法选择性胆管插管，上述方法插管成功率高，手术安全可行。

Abstract:

Objective To explore clinical strategy of a difficult selective biliary cannulation for patients having unintentional pancreaticduct cannulationduring endoscopic retrograde cholangiopancreatography (ERCP).Methods Retrospective analysis on clinical data of 63 ERCP patients having difficult selective biliary cannulation has been carried out. Patients are divided into three groups according to different methods of bile duct intubation: double guidewire group, precut pancreatic duct group, and pancreatic duct stent. We observe the success rate of bile duct intubation, the time of cannulation and the occurrence rate of postoperative complicationsin each group.Results The total success rates of cannulation in the three groups was 96.8%. The time of cannulation in the double guidewire group, pancreatic duct pre-incision group and pancreatic duct stent group were were (70.7 ± 28.6) s, (116.6 ± 43.2) s and (129.1 ± 88.2) s, respectively. There was a progressive and significant difference among all groups (P < 0.05). The total incidence of hyperamylasemia was 39.3% in post-ERCP. The hyperamylasemia in pancreatic duct pre-resection group were significantly higher than the other groups (P < 0.05); The total incidence of post-ERCP pancreatitis (PEP) was 21.3%, the PEP in pancreatic duct group was significantly higher than other two groups (P < 0.05); The Total bleeding rate was 6.6% in post-ERCP group. No severe pancreatitis or duodenal perforation occurred.Conclusion The methods of guidewire-precut pancreaticduct-pancreatic duct stent were safe and feasible, and has a high success rate in selective bile duct cannulation in ERCP.