两种方法在内镜逆行胰胆管造影术中选择 性胆管插管困难时的对照研究

Double guidewire technique VS transpancreatic precut sphincterotomy in difficult biliary cannulation

摘要:

目的 评价经内镜逆行胰胆管选行（ERCP）插管时选择性胆管插管困难时双导丝法及经胰管乳头括约肌预切开术插管这两种方法的成功率及并发症发生率。方法 回顾性分析2011年1月~2013年1月行ERCP插管时选择性胆管插管困难而导丝进入胰管时行双导丝法52例及经胰管乳头括约肌预切开术插管31例的资料，比较两种方法插管的成功率及并发症发生率。结果 52例双导丝插管组成功45例，成功率86.5%；31例经胰管乳头括约肌预切开插管成功28例，成功率90.3%，两者成功率差异无显著性（χ2=0.262，P >0.05）。双导丝组并发术后胰腺炎1例，感染1例，并发症发生率3.8%；经胰管乳头括约肌预切开组并发胰腺炎2例，出血3例，感染1例，并发症发生率19.4%；两组均无穿孔发生。双导丝组并发症发生率低于经胰管乳头括约肌预切开组（3.8% vs 19.4%，χ2=5.363，P <0.05）。结论 选择性胆总管插管困难而导丝进入胰管时，双导丝法与经胰管乳头括约肌预切开术插管成功率差异无显著性，但双导丝法并发症发生率稍低。

Abstract:

【Objective】 To evaluate double guidewire technique vs transpancreatic precut sphincterotomy for cannulation of inaccessible common bile duct in endoscopic retrograde eholangiopancreatography (ERCP). 【Methods】 83 cases of difficult bile duct cannulation in ERCP were chosen between January 2011 and January 2013, 52 cases received double guidewire technique cannulation and 31 cases were cannulated by transpancreatic septum precut sphincterotomy.The successful rate of selective bile duct cannulation and complication rate was evaluated for both groups respectively. 【Results】 Bile duct cannulation was successful in 45 of the 52 (86.5%) patients in double guidewire technique group and in 28 of 31 (90.3%) patients in transpancreatic septum precut sphincterotomy group respectively (86.5% vs 90.3%, χ2=0.262, P >0.05). Complication rate was 3.8% and 19.4 in double guidewire technique and transpancreatic precut sphincterotomy group respectively (3.8% vs 19.4%,χ2=5.363, P <0.05).【Conclusions】In case of failed selective bile duct cannulation but successful pancreatic duct cannulation, successful rate of double guide-wire technique and transpancreatic precut sphincterotomy were not significantly different, but complication rate of double guide-wire technique was lower than transpancreatic precut sphincterotomy.