三种预切开方式在插管困难的ERCP中的应用

戴欣; 张俊文

doi:10.13406/j.cnki.cyxb.001220

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三种预切开方式在插管困难的ERCP中的应用

临床研究 | 更新时间：2024-01-17

- 三种预切开方式在插管困难的ERCP中的应用
- Clinical application of three precut techniques in difficult biliary cannulation
- 重庆医科大学学报 2017年42卷第3期页码：352-356
- 作者机构：
  
  1. 重庆医科大学附属第一医院第一分院消化内科
  2. 重庆医科大学附属第一医院消化内科
- 作者简介：
- 基金信息：
- DOI：10.13406/j.cnki.cyxb.001220
  中图分类号： R656
- 纸质出版日期：2017，
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戴欣, 张俊文. 三种预切开方式在插管困难的ERCP中的应用[J]. 重庆医科大学学报, 2017,42(3):352-356.

Dai Xin, Zhang Junwen. Clinical application of three precut techniques in difficult biliary cannulation[J]. Journal of Chongqing Medical University, 2017,42(3):352-356.
戴欣, 张俊文. 三种预切开方式在插管困难的ERCP中的应用[J]. 重庆医科大学学报, 2017,42(3):352-356. DOI： 10.13406/j.cnki.cyxb.001220.

Dai Xin, Zhang Junwen. Clinical application of three precut techniques in difficult biliary cannulation[J]. Journal of Chongqing Medical University, 2017,42(3):352-356. DOI： 10.13406/j.cnki.cyxb.001220.

摘要

目的:评价经内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography

ERCP)常规插管困难时

采用双导丝法(double guide-wire technique

DGT)、经胰管乳头括约肌预切开术(transpancreatic precut sphincterotomy

TPS)、针状刀乳头括约肌预切开术(needle-knife papillotomy

NKP)3种技术的成功率及并发症发生情况

初步探讨困难插管时3种方法的有效性及安全性。方法:对2003年8月至2016年3月的3 421例经ERCP治疗的病历资料进行回顾性分析

其中3 103例需行选择性胆管插管

常规选择性胆管插管顺利者为常规插管组(standard cannulation technique

SCT)

共2 830例

273例常规胆管插管困难

其中DGT共87例

TPS共92例

NKP共94例。观察3组手术方式的操作时间、成功率及并发症发生率

并与常规插管进行比较。结果:SCT组与3种辅助插管(DGT、TPS、NKP)组的成功率分别为91.20%、96.55%、96.74%、97.87%

3种辅助插管成功率更高(P<0.05);在选择性困难插管时3种辅助插管操作时间分别为(5.89±2.03)、(5.60±2.37)、(5.76±2.50)min

较SCT组有统计学差异[(6.40±2.91)min

P<0.05];3种辅助插管高淀粉酶血症(hyperamylasaemia

PEHA)发生率分别为63.10%、41.56%、43.48%

均高于常规操作组(29.33%

P<0.05)

且DGT组高于TPS及NKP组(P<0.05);ERCP术后胰腺炎(post-ERCP pancreatitis

PEP)在SCT、DGT、TPS、NKP 4组中的发生率分别为4.50%、9.52%、5.62%、4.35%

辅助插管3组间比较无统计学差异(P>0.05)

DGT组高于SCT组

但无统计学意义(P>0.05);穿孔及出血发生率NKP分别为2.17%、6.52%

均显著高于SCT组(0.11%、0.18%

P<0.05)

且出血率较DGT(0%)及TPS组(0%)更高(P<0.05)

4组均无死亡病例。结论:3种辅助插管法在困难插管时可提高手术成功率及缩短手术时间。其中DGT组PEHA发生率较高

NKP组出血及穿孔风险较高。3组均未增加PEP发生

在选择性困难插管时3种手术方法可能是安全、有效的。

Abstract

Objective:To evaluate the success and complication rates of three precut techniques:double guide-wire technique（DGT）

transpancreatic precut sphincterotomy（TPS）

needle-knife papillotomy（NKP）in difficult biliary cannulation.Methods:Totally 273cases of difficult bile duct cannulation in endoscopic retrograde cholangiopancreatography（ERCP）were chosen between August 2003and March 2016.During the time

there are 2 830 cases received standard cannulation technique（SCT）.Eighty-seven cases received DGT and 92 cases were cannulated by TPS and 94 cases received NKP.The successful rate of selective bile duct cannulation and complication was evaluated and compared with standard cannulation

respectively.Results:The successful rates in SCT

DGT

TPS

NKP group were 91.20%

96.55%

96.74%

97.87%

respectively.The successful rate in three precut techniques was higher than that in standard cannulation（P<0.05）.The time of successful biliary cannulation in DGT

TPS and NKP group was（5.89±2.03）

（5.60±2.37）

（5.76±2.50）min

respectively

with statistically significant differences compared with that of（6.40±2.91）min in standard cannulation group（P<0.05）.The hyperamylasemia（PEHA）rates in DGT

TPS

NKP group were 63.10%

41.56%

43.48%

respectively.The rate of PEHA in three precut techniques was higher than that in standard cannulation（P<0.05）.Meanwhile

the rate of PEHA in DGT group was higher than that in TPS and NKP group（P<0.05）.The incidence of post-ercp pancreatitis（PEP）was not statistical different in three groups（P>0.05）.The incidences of perforation and bleeding in NKP were 2.17%and 6.52%

respectively

which was significantly higher than those of standard cannulation（0.11%

0.18%

P<0.05）and the incidence of bleeding was significantly higher than that in DGT（0%）and TPS（0%）group.There was no death in either group.Conclusion:All of the three precut techniques could increase the success rate of biliary cannulation and shorten the operation time.Among them

DGT has higher rate of PEAP.Meanwhile

NKP has higher rate of perforation and bleeding.But three precut techniques do not increase the rate of post-ERCP pancreatitis.The use of different strategies may help increase the success rate for difficult biliary cannulation without increasing complication rates.

关键词

内镜逆行胰胆管造影困难插管双导丝法经胰管乳头括约肌预切开针状刀乳头括约肌预切开

Keywords

endoscopic retrograde cholangiopancreatographydifficult biliary cannulationdouble guide-wire techniquetranspancreatic precut sphincterotomyneedle-knife papillotomy

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