内镜夹闭乳头成形术在内镜逆行胰胆管造影术中的应用

Utilization of endoclip papilloplasty in endoscopic retrograde cholangiopancreatography

摘要:

目的 探讨内镜夹闭乳头成形术在内镜逆行胰胆管造影术（ERCP）中的临床应用价值。方法 选取2021年11月－2022年11月该院行ERCP的患者62例。随机行内镜乳头夹闭成形术32例，成功30例。分为两组，内镜夹闭乳头成形术成功组（A组，n = 30）和十二指肠乳头未夹闭组（B组，n = 30）。比较两组患者的近期并发症和远期并发症发生率。结果 内镜夹闭乳头成形术的成功率为93.8%（30/32）。两组患者术后胰腺炎、术后出血和术后胆管炎的发生率比较，差异均无统计学意义（P > 0.05）；两组患者均无十二指肠穿孔病例。两组患者1年内胆管炎发病率和胆总管结石复发率比较，差异均无统计学意义（P > 0.05），但A组胆管炎发生率+结石复发率明显低于B组，差异有统计学意义（P < 0.05）。结论 内镜夹闭乳头成形术对内镜下乳头括约肌大球囊扩张术（EPLBD）后乳头的夹闭成形成功率高，手术安全，可减少远期胆管炎的发生，降低结石复发率。

Abstract:

Objective To explore the clinical utility of endoclip papilloplasty in endoscopic retrograde cholangiopancreatography (ERCP).Methods A prospective study was conducted and selected 62 patients who underwent ERCP from November 2021 to November 2022. 30 out of 32 patients who randomly underwent endoclip papilloplasty were successful. These patients were assigned to successful endoclip papilloplasty group (group A, n = 30) or the duodenal papilla unclamping group (group B, n = 30). The aim was to compare the difference in short-term and long-term complications between the two groups.Results The success rate of papillary plasty was 93.8% (30/32), with no statistically significant differences observed in the incidence of postoperative pancreatitis, postoperative hemorrhage after ERCP, and postoperative cholangitis between the two groups (P > 0.05). The duodenal perforation rate was 0. There were no significant differences between the two groups in terms of total cholangitis incidence and recurrence rate of calculus of common bile duct within 1 year (P > 0.05). However, there was a statistical difference in terms of total the incidence of cholangitis + calculus of common bile duct recurrence within 1 year (P < 0.05).Conclusion The endoclip papilloplasty exhibits a high success rate and safety and feasibility procedure reducing long-term recurrence rate of cholangitis and calculus of common bile duct in endoscopic papillary large balloon dilation (EPLBD) procedure .