不同类型内镜逆行胰胆管造影术困难插管患者行胰管括约肌预切开术后的近期和远期疗效评价

Evaluation of short-term and long-term effects of preincision of pancreatic duct sphincter in patients with different types of endoscopic retrograde cholangiopancreatography difficult to intubate

摘要:

目的 探讨不同类型内镜逆行胰胆管造影术（ERCP）困难插管患者行胰管括约肌预切开术后的近期和远期疗效。方法 回顾性分析2019年1月－2020年6月该院收治的100例ERCP插管困难患者的临床资料，按照治疗方法不同，将患者分为对照组（50例）和研究组（50例），对照组行常规ERCP插管，不做胰管切开，研究组在行常规ERCP插管的基础上，行胰管括约肌预切开术；统计两组患者插管成功时间、成功插管率和住院时间；采用酶联免疫吸附试验，检测两组患者术后C反应蛋白（CRP）、白细胞介素-6（IL-6）和血淀粉酶水平；统计两组患者预切开操作相关的并发症发生率；随访两组患者术后3、6和12个月的反流性胆管炎和复发性胰腺炎发生情况，评价两组患者远期疗效。结果 与对照组比较，研究组成功插管时间缩短，成功插管率增加，差异均有统计学意义（P < 0.05），两组患者住院时间比较，差异无统计学意义（P > 0.05）；与对照组比较，研究组术后第1天CRP、IL-6和血淀粉酶水平降低，差异均有统计学意义（P < 0.05）；对照组急性胰腺炎4例，出血2例，穿孔1例，术后并发症发生率为14.0%，研究组出血1例，术后并发症发生率为2.0%，研究组明显低于对照组，差异有统计学意义（P < 0.05）；与对照组比较，研究组术后12个月反流性胆管炎发生率降低，术后3、6和12个月复发性胰腺炎发生率降低，差异均有统计学意义（P < 0.05）。结论 胰管括约肌预切开术对ERCP困难插管患者全身炎症影响较轻，血淀粉酶指标正常，且未增加术后胰腺炎等并发症发生率，可提高插管成功率，远期疗效显著，安全、有效，值得临床应用。

Abstract:

Objective To investigate the short and long term effects of preincision of pancreatic duct sphincter in different types of patients with difficult intubation by endoscopic retrograde cholangiopancreatography (ERCP).Method A retrospective study was conducted on 100 patients with difficulty in ERCP intubation from January 2019 to June 2020. Patients were divided into a control group (50 cases) and a study group (50 cases) according to different treatment methods. The control group underwent routine ERCP intubation without pancreaticotomy, while the study group underwent preincision of pancreatic duct sphincter on the basis of routine ERCP intubation. Calculate the successful intubation time, successful intubation rate, and length of hospital stay for two groups; Enzyme linked immunosorbent assay was used to detect postoperative C-reactive protein (CRP), interleukin-6 (IL-6), and blood amylase levels in two groups of patients; Calculate the incidence of complications related to pre incision surgery in two groups of patients; Follow up the incidence of reflux cholangitis and recurrent pancreatitis in two groups of patients at 3, 6, and 12 months after surgery, and evaluate the long-term efficacy of the two groups of patients.Result Compared with the control group, the study group showed a shorter in successful intubation time, and an increase in successful intubation rate (P < 0.05). There was no difference in hospital stay between the two groups (P > 0.05); Compared with the control group, the study group showed a decrease in CRP, IL-6 and blood amylase levels on the first day after surgery (P < 0.05); The postoperative complication rate of patients in the control group was 14.0%, including 4 patients with acute pancreatitis, 2 patients with bleeding, and 1 patient with perforation. The postoperative complication rate of patients in the study group was 2.0%, with 1 patient with bleeding. Compared with the control group, the postoperative complication rate of patients in the study group decreased (P < 0.05); Compared with the control group, the incidence of reflux cholangitis in the study group decreased at 12 months after surgery, and the incidence of recurrent pancreatitis decreased at 3, 6, and 12 months after surgery (P < 0.05).Conclusion Preincision of the pancreatic duct sphincter has a mild impact on systemic inflammation in patients with difficult ERCP intubation, with normal blood amylase indicators and no increase in the incidence of postoperative pancreatitis. It can improve the success rate of intubation and has significant long-term efficacy. It is a safe and effective technique which is worth recommending.