本文選題：內(nèi)鏡逆行胰膽管造影　切入點(diǎn)：經(jīng)胰管乳頭括約肌預(yù)切開　出處：《中國內(nèi)鏡雜志》2017年08期

【摘要】：目的探討經(jīng)胰管膽胰管隔膜切開術(shù)及雙導(dǎo)絲術(shù)在困難性插管內(nèi)鏡逆行胰膽管造影術(shù)(ERCP)中的應(yīng)用及安全性。方法回顧性分析2012年1月-2014年1月行ERCP插管時選擇性膽管插管困難患者158例,根據(jù)插管方法分為經(jīng)胰管膽胰管隔膜切開法(A組)、雙導(dǎo)絲法(B組)和單導(dǎo)絲法(C組)3組。比較三種方法插管的成功率及并發(fā)癥發(fā)生率。結(jié)果 58例A組患者插管成功54例,成功率93.1%,56例B組患者插管成功50例,成功率89.3%,44例C組患者插管成功26例,成功率59.1%,A和B組成功率差異無統(tǒng)計(jì)學(xué)意義(P0.05),A與C組,B與C組差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。A組并發(fā)胰腺炎4例,出血6例,感染2例,并發(fā)癥發(fā)生率20.7%;B組并發(fā)術(shù)后胰腺炎5例,感染4例,并發(fā)癥發(fā)生率16.1%;C組并發(fā)胰腺炎7例,出血2例,感染4例,并發(fā)癥發(fā)生率29.5%,3組均無穿孔發(fā)生。B組并發(fā)癥發(fā)生率略低于A組,但無明顯差異(P0.05),A與C組,B與C組并發(fā)癥發(fā)生率均差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論選擇性膽管插管困難而導(dǎo)絲進(jìn)入胰管時,繼續(xù)常規(guī)單導(dǎo)絲插管成功率低且并發(fā)癥發(fā)生率較高,經(jīng)胰管乳頭括約肌預(yù)切開術(shù)與雙導(dǎo)絲法均可有效提高插管成功率,且并發(fā)癥發(fā)生率均相對較低,兩者之間無明顯差異。
[Abstract]:Objective to investigate the application and safety of transhepatic cholangiopancreatotomy and double wire guide in endoscopic retrograde cholangiopancreatography (ERCP) with difficult intubation. Methods the selective bile duct during ERCP intubation from January 2012 to January 2014 was retrospectively analyzed. 158 patients with difficult intubation, According to the method of intubation, the patients were divided into three groups: group A, group A, group B, group B, respectively. The success rate and the incidence of complications of the three methods were compared between group A and group C. results there were 54 cases of successful intubation in group A. The success rate was 93.1% in 56 patients in group B, 50 cases in group B, and 26 cases in group C with a success rate of 89.3%. There was no significant difference in success rate between group A and group B (P 0.05) and group C (P 0.05). 4 cases of pancreatitis were complicated with pancreatitis in group A (P 0.05) and group C (n = 4). There were 6 cases of hemorrhage, 2 cases of infection, 5 cases of postoperative pancreatitis, 4 cases of infection, 7 cases of complicated pancreatitis, 2 cases of hemorrhage and 4 cases of infection. The incidence of complications in group B was slightly lower than that in group A, and the incidence of complications in group B was slightly lower than that in group A. But there was no significant difference in the incidence of complications between group A and group C (P 0.05). Conclusion when selective bile duct intubation is difficult and lead wire enters the pancreatic duct, the success rate of continuous routine single-wire intubation is low and the incidence of complications is higher. The successful rate of intubation could be increased effectively by pre-operation of pancreatic duct papillary sphincter and double guide wire, and the incidence of complications was relatively low, and there was no significant difference between the two.
【作者單位】： 上海市普陀區(qū)人民醫(yī)院消化內(nèi)科;江蘇省無錫市第二人民醫(yī)院消化內(nèi)科;
【分類號】：R657.4

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