本文選題：內(nèi)鏡逆行胰膽管造影　切入點(diǎn)：困難插管　出處：《重慶醫(yī)科大學(xué)學(xué)報(bào)》2017年03期 　論文類型：期刊論文

【摘要】：目的:評(píng)價(jià)經(jīng)內(nèi)鏡下逆行胰膽管造影術(shù)(endoscopic retrograde cholangiopancreatography,ERCP)常規(guī)插管困難時(shí),采用雙導(dǎo)絲法(double guide-wire technique,DGT)、經(jīng)胰管乳頭括約肌預(yù)切開(kāi)術(shù)(transpancreatic precut sphincterotomy,TPS)、針狀刀乳頭括約肌預(yù)切開(kāi)術(shù)(needle-knife papillotomy,NKP)3種技術(shù)的成功率及并發(fā)癥發(fā)生情況,初步探討困難插管時(shí)3種方法的有效性及安全性。方法:對(duì)2003年8月至2016年3月的3 421例經(jīng)ERCP治療的病歷資料進(jìn)行回顧性分析,其中3 103例需行選擇性膽管插管,常規(guī)選擇性膽管插管順利者為常規(guī)插管組(standard cannulation technique,SCT),共2 830例,273例常規(guī)膽管插管困難,其中DGT共87例,TPS共92例,NKP共94例。觀察3組手術(shù)方式的操作時(shí)間、成功率及并發(fā)癥發(fā)生率,并與常規(guī)插管進(jìn)行比較。結(jié)果:SCT組與3種輔助插管(DGT、TPS、NKP)組的成功率分別為91.20%、96.55%、96.74%、97.87%,3種輔助插管成功率更高(P0.05);在選擇性困難插管時(shí)3種輔助插管操作時(shí)間分別為(5.89±2.03)、(5.60±2.37)、(5.76±2.50)min,較SCT組有統(tǒng)計(jì)學(xué)差異[(6.40±2.91)min,P0.05];3種輔助插管高淀粉酶血癥(hyperamylasaemia,PEHA)發(fā)生率分別為63.10%、41.56%、43.48%,均高于常規(guī)操作組(29.33%,P0.05),且DGT組高于TPS及NKP組(P0.05);ERCP術(shù)后胰腺炎(post-ERCP pancreatitis,PEP)在SCT、DGT、TPS、NKP 4組中的發(fā)生率分別為4.50%、9.52%、5.62%、4.35%,輔助插管3組間比較無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),DGT組高于SCT組,但無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);穿孔及出血發(fā)生率NKP分別為2.17%、6.52%,均顯著高于SCT組(0.11%、0.18%,P0.05),且出血率較DGT(0%)及TPS組(0%)更高(P0.05),4組均無(wú)死亡病例。結(jié)論:3種輔助插管法在困難插管時(shí)可提高手術(shù)成功率及縮短手術(shù)時(shí)間。其中DGT組PEHA發(fā)生率較高,NKP組出血及穿孔風(fēng)險(xiǎn)較高。3組均未增加PEP發(fā)生,在選擇性困難插管時(shí)3種手術(shù)方法可能是安全、有效的。
[Abstract]:Objective: to evaluate the difficulty of endoscopic retrograde cholangiopancreatography (ERCP) in the routine intubation of cholangiopancreatic cholangiopancreatography (ERCP) by endoscopic retrograde cholangiopancreatography. The success rate and complications of double guide-wire technique (DGTT), transphincterotomy (TPS) and needle-knife sphincterotomytomy (TPS) were studied. Methods: the clinical data of 3 421 patients treated with ERCP from August 2003 to March 2016 were analyzed retrospectively, 3 103 of them needed selective bile duct intubation. The routine selective bile duct intubation was performed successfully in the routine cannulation technique group (n = 2 830 cases), including 87 cases of DGT (n = 92) and 94 cases (n = 94). The operative time, success rate and complication rate of the three groups were observed. Results compared with routine intubation, the success rates of the two groups were 91.209.55 and 96.747.877.877.The operative time of the three kinds of intubation in selective difficult intubation was 5.89 鹵2.035.60 鹵2.37t 5.76 鹵2.50 min, respectively, which was higher than that in the SCT group (P < 0.05), which was significantly higher than that in the SCT group (P < 0.05), which was significantly higher than that in the SCT group (P < 0.05), which was significantly higher than that in the SCT group (P < 0.05), which was higher than that in the SCT group (5.89 鹵2.03g / min vs 5.76 鹵2.50 min). Statistical difference [6.40 鹵2.91 min] the incidence of hyperamylasemiaemia and hyperamylasaemiafida PEHAA were 63.1010, 41.56 and 43.48, respectively, which were higher than those of routine operation group (29.33%, P 0.05), and that of DGT group was higher than that of TPS group and NKP group (P 0.05). The incidence of post-ERCP creatitis-PEP in SCTD GTV / TPSNK4 group was 4.500.9.52% and 5.62%, 4.35% respectively. There was no statistical difference between the two groups. P0.05DGT group was higher than SCT group. The incidence of perforation and hemorrhage was 2.17 and 6.52, respectively, which was significantly higher than that in SCT group (0.110.18), and the bleeding rate was higher than that in DGT0 and TPS groups. Conclusion all of the three auxiliary intubation methods can improve the operation when intubation is difficult. The incidence of PEHA in DGT group was higher than that in NKP group and the risk of hemorrhage and perforation was higher in group 3. The incidence of PEP was not increased in DGT group. The three surgical procedures may be safe and effective when selective intubation is difficult.
【作者單位】： 重慶醫(yī)科大學(xué)附屬第一醫(yī)院第一分院消化內(nèi)科;重慶醫(yī)科大學(xué)附屬第一醫(yī)院消化內(nèi)科;
【分類號(hào)】：R656

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