本文選題：內鏡逆行胰膽管造影術 + 經胰管��； 參考：《青島大學》2014年碩士論文

【摘要】：目的探討ERCP時盡早經胰管括約肌預切開后膽管插管的安全性。 方法前瞻性觀察2011年10月至2013年8月在我院行ERCP治療的患者,將112例符合入選標準的患者納入研究。按1：3的比例隨機分為兩組：A組導絲首次進入胰管即行經胰管括約肌預切開；B組繼續(xù)嘗試常規(guī)膽管插管15min,15min內膽管插管成功者為B1組,15min膽管插管仍失敗或導絲反復進入胰管5次時再行經胰管括約肌預切開者為B2組。統(tǒng)計各組膽管插管成功率、膽管插管時間、X線照射時間、并發(fā)癥的發(fā)生率和術后急性胰腺炎相關的危險因素。 結果A組所用膽管插管時間、X線照射時間均比B2組短,差異有統(tǒng)計學意義(7.9min與16.9min,5.8min與10.4min,P0.05)。A組與B2組的膽管插管成功率,無統(tǒng)計學差異,但B2組胰腺炎發(fā)生率明顯高于A組(26.9%與3.4%,P=0.02)。多變量分析提示：插管時間10min、導絲進入胰管2次是術后急性胰腺炎的危險因素。 結論對ERCP首次插管導絲進入胰管的患者盡早行經胰管括約肌預切開是安全的,有利于減少急性胰腺炎的發(fā)生率。
[Abstract]:Objective to investigate the safety of bile duct intubation after early transphincterotomy through pancreatic sphincter on ERCP. Methods from October 2011 to August 2013, 112 patients with ERCP were enrolled in the study. According to the 1:3 ratio, two groups were randomly divided into two groups: group 1: group A: first entering the pancreatic duct, group B continued to attempt routine bile duct intubation within 15 minutes or 15 minutes, the group B1 failed to intubate the duct at 15 minutes or the lead wire was repeatedly inserted into the pancreatic duct, and the group B continued to attempt the routine bile duct intubation within 15 minutes or 15 minutes after the successful intubation. Group B2 was treated with pre-incision of pancreatic sphincter after 5 times of pancreatic duct entry. The success rate of bile duct intubation, the time of bile duct intubation and X-ray irradiation time, the incidence of complications and the risk factors of postoperative acute pancreatitis were analyzed. Results the time of bile duct intubation in group A was shorter than that in group B2, and the difference was statistically significant (7.9min, 16.9min, 5.8min and 10.4min). There was no significant difference in the successful rate of bile duct intubation between group A and group B2, but the incidence of pancreatitis in group B2 was significantly higher than that in group A (26.9%) and group B (3.4P 0.02). Multivariate analysis showed that intubation time was 10 min and the lead wire entering the pancreatic duct twice was the risk factor of postoperative acute pancreatitis. Conclusion it is safe for the patients with ERCP first intubation to enter the pancreatic duct as early as possible through the pancreatic sphincter, which is helpful to reduce the incidence of acute pancreatitis.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R576

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本文編號：1785076