乳头扩约肌预切开术在困难插管内镜逆行胰胆管造影术中的疗效分析

Efficiency analysis of precut sphincterotomy in ERCP with difficult cannulation

目的探讨十二指肠乳头预切开术在内镜逆行胰胆管造影术(ERCP)中的应用,并评价其在ERCP中的作用和安全性。方法自2008年1月至2011年6月我院肝胆胰外科共完成内镜下逆行胰胆管造影术930例,其中选择性插管困难者采用常规方法不能完成而采用乳头预切开术108例,占11.6%。纳入标准为常规插管失败或反复进入胰管4次判定为选择性插管困难,术中改行乳头预切开术,根据病情完成ERCP检查和内镜下治疗。观察终点为治疗成功率和并发症发生率,并与同期常规ERCP插管病例资料对比分析。统计学处理采用SPSS 13.0统计软件,率的比较采用χ2检验,P<0.05为差异有统计学意义。结果本组乳头预切开术108例,ERCP成功103例,成功率95.4%。术后并发症7例,发生率6.5%,无十二指肠穿孔及死亡病例。同期822例常规ERCP诊治成功率97.7%,术后并发症63例,发生率7.7%。乳头预切开与常规选择性胆管插管两组患者的并发症发生率(χ2=0.141,P=0.707)及成功率(χ2=2.041,P=0.153)差异无统计学意义。结论乳头预切开术与常规ERCP相比不增加发生并发症的风险,可提高困难ERCP的成功率,但要严格掌握适应证,由经验丰富的医师进行。

Objective To investigate the clinical application value,efficiency and safety of precut sphincterotomy in endoscopic retrograde cholangio-pancreatography(ERCP).Methods From January 2008 to June 2011,930 patients received ERCP in the department of hepatobiliary surgery of the first hospital of Jilin University.Of them 108 cases(11.6%) were diverted to receive precut sphincterotomy,because selective bile duct cannulation with conventional method was difficult.Inclusion criteria: failure of conventional cannulation or repeating pancreatic duct cannulation for more than 4 times.According to the patient's conditions,the examination and treatment of ERCP was carried out.Observation termination are therapeutic success rate and the incidence rate of complications,and comparative analysis on case data of routine ERCP was made.Statistical analysis was executed by SPSS 13.0 software.Comparison of ratio were determined with χ2 test,a value less than 0.05 was considered as significant.Results Of 108 cases,the success rate of ERCP was 95.4%(103 cases).The incidence rate of complications was 6.5%,and there are no cases of duodenal perforation and death.Amongst 822 cases of routine ERCP,therapeutic success rate was 97.7%,and the incidence rate of complications was 7.7%.The statistics analysis result indicates that there are no statistical differences between precut sphincterotomy group and routine ERCP groups in the success rate(χ2=2.041,P=0.153) and the incidence rate of complications(χ2=0.141,P=0.707).Conclusion The precut sphincterotomy in ERCP are safe and obviously effective with less complications compared to routine ERCP.The successful probability of difficult ERCP is improved greatly by using the technique of precut sphincterotomy.But the precut sphincterotomy indication is strictly controlled,and the technique should be performed by experienced endoscopist.