ERCP中选择性胆管插管技术与经验

ASSOCIATION OF THE CONFLUENCE OF PANCREATICOBILIARY DUCTAL WITH THE SUCCESS RATE OF SELECTIVE BILE DUCT CANNULATION

目的探讨如何提高ERCP选择性胆管插管成功率。方法总结分析2007～2009年我院进行ERCP诊断治疗中需进行选择性胆管插管造影204例,对所有病例胆胰汇合方式均进行回顾性视频录像分析,研究分析如何提高选择性胆管插管的成功率。结果全组204例病例直接通过拉式弓状切开刀进行插管成功185例,经针状刀预切开插管成功3例,共成功188例,成功率为92.2%;失败16例,失败率为7.8%,失败病例中有14例为胆胰管共同通道型。全组没有胆胰管同时显影病例。结论选择性胆管插管成功率与患者配合程度、操作技术因素、乳头形态、胆胰汇合方式等有密切联系。与患者良好沟通、提高操作技术,仔细观察乳头形态,短切开乳头以改变胰胆管汇合方式等可提高选择性胆管插管成功率。

Objective To explore how to increase the success rate of selective bile duct cannulation.Methods A retrospective study of 204 cases that needed selective bile duct cannulation from December,2007 to December,2009 in our institution,we tried to analyze how to increase the success rate of selective billary cannulation.Results 185 cases was intubated successfully by the pull-type papillotomy,3 cases was intubated by needle-knife in total 204 cases（188/204,92.2%）;16 cases was failured（16/204,7.8%）,14 of them was type of biliary pancreatic duct common channel.cholangiopancreatography was not been seen in the whole group.Conclusion The successful rate of intubation of the bile duct was distinctly correlated with factor of operator,shape of duodenal papilla and the type of biliary pancreatic duct common channel.Good communication with patients,improved technology,carefully observed duodenal papilla and short-cut the duodenal papilla to change the type of biliary pancreatic duct common channel,it can increase the success rate of selective billary cannulation.