3种辅助插管技术在ERCP胆管插管困难病例中的临床应用

摘要

目的对比双导丝插管技术、针状刀乳头预切开术与经胰管乳头预切开术3种辅助插管技术在ERCP胆管插管困难病例中的成功率和并发症发生率，探讨安全有效的辅助插管技术。方法将104例经内镜逆行胰胆管造影（ERCP）选择性胆管插管困难患者随机分成3组分别行3种不同辅助插管技术，即双导丝插管术组（A组）35例，针状刀乳头预切开组（B组）35例，经胰管乳头预切开组（C组）34例。对比3组患者辅助胆管插管的成功率、获得成功插管的时间与并发症的发生率。结果 A组辅助插管成功率为51．43%（18/35），B组为91.43%（32/35），C组为70.59%（24/34），3组成功率差异均有统计学意义（P<0.05）。3组成功插管时间分别为（7.83±1.08）min，（8.20±0.91）min和（7.91±1.20）min，3组成功插管时间无显著性差异（P>0.05）。3组患者术后胰腺炎发生率分别为：2.86%（1/35），22.86%（8/35）与8.82%（3/34），3组间术后胰腺炎发生率差异有统计学意义（P<0.05）。3组患者均无严重感染、大出血、穿孔等并发症发生。结论3种辅助插管技术均可提高胆管插管成功率，其中针状刀乳头预切开术与经胰管乳头预切开术有更高的成功率，但术后胰腺炎等并发症发生率亦较高；双导丝插管术成功率较低，但安全性较高。%Objective To compare the effectiveness and post-ERCP complications of three assisted catheterizations in difficult biliary cannulation. Methods A total of 104 cases of difficult biliary cannulations in ERCP were randomly divided into three groups, and then separately received three kinds of assisted catheterizations. Group A received double-guide wire technique (n=35), group B received needle-knife sphincterotomy (n=35), and group C received pre-cut of pancreatic duct(n=34). Comparisons for the suc-cess rate, procedure time and complications were performed among the three groups. Results The success rate of group B(91.43%, 32/35) was higher than that of group C(70.59%, 24/34)and group A(51.43%, 18/35)(P<0.05).The time of successful biliary cannulation in group A,B and C was (7.83 ± 1.08)minutes,(8.20 ± 0.91) minutes and(7.91 ± 1.20)minutes respectively, there was no significant difference among the there groups(P>0.05).With regard to the incidence of post-ERCP pancreatitis, group B(22.86%, 8/35)was much higher than group C(8.82%, 3/34)and group A (2.86%,1/35)(P<0.05). There were no serious complications such as in-fection, hemorrhage or perforation in either group. Conclusion All of the three assisted catheterizations could increase the success rate of biliary cannulation, needle-knife sphincterotomy and pre-cut of pancreatic duct could gain higher success rate with more post-ERCP complications, while double-guide wire technique, though with a lower success rate, was much safer.