摘要
目的比较两种插管方法在ERCP选择性胆管插管困难时的成功率和并发症发生率。方法将85例接受胆管ERCP治疗时反复插入胰管的选择性插管困难患者随机分成两组,胰管留置导丝组(A组)42例,采用胰管留置导丝技术,胰管预切开组(B组)43例,采用胰管预切开技术。记录两组的成功率、ERCP术后4h、24h血淀粉酶、ERCP术前及术后24h白血球计数、体温、腹痛以及ERCP术后胰腺炎发生率,并对两组进行比较。结果成功率:A组为85.7%(36/42),B组为88.4%(38/43)。ERCP术后胰腺炎发生率:A组4.8%(2/42),B组16.3%(7/43)例,差异有统计学意义。术后高淀粉酶血症发生率:A组7.1%(3/42),B组20.9%(9/43),差异有统计意义。腹痛发生率:A组11.9%(5/42),B组16.3%(7/43)。术后发热或血象升高发生率:A组4.8%(2/42),B组4.7%(2/43)。结论ERCP选择性胆管插管困难时采用胰管导丝留置法可有效提高成功率,减少并发症尤其是ERCP术后胰腺炎和高淀粉酶血症的发生率。
Objective To compare the effectiveness of two techniques in difficult or failed selective bile duct cannulations and occurrence of post-ERCP complications. Methods Eighty-five cases of difficult selective bile duct cannulation in ERCP were randomly divided into two groups. Indwelling pancreatic duct gnidewires were used in group A ( n = 42 ), while in group B ( n = 43 ) , pre-cut of pancreatic duct was performed. Such variables as rate of successful bile duct cannulation, post-ERCP blood amylase 4 and 24 hourly, occurence of pancreatitis, and count of white blood cell , temperature, abdominal pain before and after ERCP were compared between the two groups. Results In group A,the success rate of ERCP was 85.7% (36/42) , whereas that of group B was 88.4% (38/43). There was significant difference in occurrence of post-ERCP pancreatitis between the two groups with 2 in group A and 7 in group B(P〈0.01). There was also significant difference in occurrence of hyperamylasemia with 3 cases in group A ( 7.1% ) and 9 in group B ( 20.9% ) ( P 〈 0. 01 ). The occurrences of abdominal pain were 11.9% ( 5/42 ) and 16. 3% ( 7/43 ) respectively. Two case of leukocytosis and/or fever occurred in both groups ( P 〉 0. 05 ). There was no procedure-related mortality. Condusion In difficult or failed selective bile duet cannulation during ERCP, indwelling gnidewire method, more effective and safe, can reduce the rate of complications, especially post- ERCP pancreatitis and hyperamylasemia.
出处
《中华消化内镜杂志》
2008年第2期73-76,共4页
Chinese Journal of Digestive Endoscopy