肝胰壶腹特征分类预测内镜逆行胰胆管造影术插管成功率和并发症发生率的价值

Predictive value of hepatopancreatic ampulla features on the success of endoscopic retrograde cholangiopancreatography cannulation and complication rates

摘要:

目的 探讨肝胰壶腹特征预测内镜逆行胰胆管造影术（ERCP）插管成功率和并发症发生率的价值。方法 回顾性分析2023年6月－2023年10月华东地区两家医院行ERCP治疗的400例患者的临床资料，按肝胰壶腹特征，将患者分为不突出组（n = 184）、突出组（n = 76）、憩室、黏膜褶皱组（n = 101）和扭曲、肿瘤累及组（n = 39）。记录插管时乳头接触次数、插管成功时间和手术相关并发症等情况。结果 扭曲、肿瘤累及组插管时乳头接触次数最多，为（8.95±6.30）次，不突出组接触次数最少，为（4.01±2.42）次，4组患者乳头接触次数比较，差异有统计学意义（F = 31.06，P = 0.000）。扭曲、肿瘤累及组插管成功时间最长，为（353.96±263.42）s，不突出组插管成功时间最短，为（161.03±118.06）s，4组患者插管成功时间比较，差异有统计学意义（F = 17.73，P = 0.000）。共31例患者（7.75%）发生并发症。其中，术后胰腺炎最多，无穿孔和死亡病例。结论 肝胰壶腹特征是预测ERCP插管成功率和并发症发生率的一种简单、可行的方法。未来，其有望成为预测胆管插管难易程度的因素。

Abstract:

Objective To study the predictive value of features of the hepatopancreatic ampulla on the success of endoscopic retrograde cholangiopancreatography (ERCP) cannulation and complication rates.Methods Clinical data of 400 patients who underwent ERCP from June 2023 to October 2023 at two hospitals in Eastern China were retrospectively analyzed, patients were divided into non-protruding group (n = 184), protruding group (n = 76), diverticulum, mucosal folds group (n = 101) and twisted, tumour involved group (n = 39) according to hepatopancreatic ampulla features. The frequency of nipple contact during intubation, time to successful intubation, and procedure-related complications were recorded separately.Results The highest mean number of contacts in the nipple contact frequency was found in the twisted, tumour-involved group (8.95 ± 6.30) times, and the lowest number of contacts was found in the non-protruding group (4.01 ± 2.42) times, the difference was statistically significant in four groups (F = 31.06, P = 0.000). Hepatopancreatic ampulla features were a significant factor influencing cannulation time, with prolonged cannulation time observed in the twisted, tumour-involved group (353.96 ± 263.42) s and fastest cannulation in the non-protruding group (161.03 ± 118.06) s, the difference was statistically significant in four groups (F = 17.73, P = 0.000). A total of 31 patients (7.75%) experienced complications, with the highest number of post-ERCP pancreatitis and no cases of perforation or death.Conclusion Hepatopancreatic ampulla features are a simple and feasible way to predict the success of ERCP cannulation and the incidence of complications. In the future, it could be used as a biological predictor of the difficulty of bile duct cannulation.