【摘要】：背景:內(nèi)鏡逆行胰膽管造影術(shù)(ERCP)多應(yīng)用于膽胰疾病的診治,且臨床效果良好。選擇性膽管插管的成功是ERCP進一步診治膽道疾病的基礎(chǔ)。如何提高膽管插管的成功率,仍是內(nèi)鏡醫(yī)師最關(guān)注的焦點。目的:通過綜述分析ERCP選擇性膽管插管困難原因及提高膽管插管成功率的對策,從而為ERCP過程中成功膽管插管提供一些參考。方法:以“選擇性膽管插管困難原因,困難性插管,乳頭預(yù)切開術(shù),胰管占據(jù)法”等關(guān)鍵詞進行檢索,找出提高膽管插管成功率的研究,并對各種方法選擇時機及可能出現(xiàn)的并發(fā)癥作出總結(jié)。結(jié)果與結(jié)論:目前有大量文獻報道選擇性膽管插管困難原因及如何提高膽管插管的成功率,綜合研究結(jié)果表明,選擇性膽管插管困難原因有:患者本身的病理或解剖因素、操作內(nèi)鏡醫(yī)師的水平、器械原因;預(yù)切開術(shù)應(yīng)用于無法進入乳頭者,胰管占據(jù)法應(yīng)用于反復(fù)進入胰管者,擇期行二次ERCP應(yīng)用于行預(yù)切開后仍無法成功膽管插管者,會師技術(shù)應(yīng)用于ERCP失敗的膽道梗阻患者。
[Abstract]:Background: endoscopic retrograde cholangiopancreatography (ERCP) is widely used in the diagnosis and treatment of biliary and pancreatic diseases. The success of selective bile duct intubation is the basis of ERCP in the diagnosis and treatment of biliary diseases. How to improve the success rate of bile duct intubation is still the focus of endoscopic physicians. Objective: to summarize and analyze the causes of ERCP selective bile duct intubation and the countermeasures to improve the success rate of bile duct intubation so as to provide some references for successful bile duct intubation in the process of ERCP. Methods: the key words of "selective bile duct intubation difficulty, difficult intubation, papillectomy and pancreatic duct occupation" were used to find out how to improve the success rate of bile duct intubation. The timing and possible complications of various methods were summarized. Results and conclusion: there are a large number of reports on the causes of selective bile duct intubation and how to improve the success rate of selective bile duct intubation. The comprehensive results show that the causes of selective bile duct intubation difficulties are the pathological or anatomical factors of the patients themselves. The level of endoscopic surgeon and the cause of the instrument; Pre-incision was applied to those who could not enter the papilla, pancreatic duct occupation method was applied to those who repeatedly entered the pancreatic duct, selective secondary ERCP was applied to those who could not successfully intubate the bile duct after pre-incision, and the technique of association was applied to the patients with biliary tract obstruction who had failed in ERCP.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R657.4

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