双导丝插管技术在肝移植术后胆道并发症致胆总管插管困难病例中的应用价值探讨

Double-guide wire technique for difficult bile duct cannulation in patients due to biliary complications after liver transplantation

目的探讨双导丝插管技术在肝移植术后胆道并发症致ERCP插管困难病例中的应用价值。方法91例肝移植术后胆道并发症致ERCP插管困难患者，在判定困难插管的10min插管时间内导丝已进入胰管的6例患者纳入双导丝组，其他85例患者按抽签单双号方式随机分为2组。双导丝组44例，男41例、女3例，年龄30～61岁，平均41岁；常规组47例，男41例、女6例，年龄33—56岁，平均43岁。2组均尝试插管20min后终止，对2组胆总管插管成功率、获得成功插管的时间、术后并发症发生情况进行统计学分析。结果双导丝组胆总管插管成功率为36／44（81．8％），常规组为33／47（70．2％），2组差异无统计学意义（P〉0．05）。双导丝组获得成功插管的时间为（11．7±3．2）min，明显短于常规组的（16．8±2．8）min（P〈0．05）。双导丝组术后高淀粉酶血症发生率为25．0％（11／44），常规组为21．3％（10／47），2组差异无统计学意义（P〉0．05）；2组术后均无严重感染、大出血和穿孔并发症发生，常规组术后确诊2例轻度胰腺炎，双导丝组无一例发生胰腺炎。结论双导丝插管技术能较快地获得成功胆总管插管，未较常规插管明显增加并发症发生率，可在肝移植术后致ERCP插管困难病例中尝试使用。

Objective To compare the double-guide wire technique （DGT） with the standard can- nulation technique （SCT） in patients with difficult access due to biliary complications after liver transplanta- tion. Methods Difficult CBD cannulation is characterized by unsuccessful cannulation in 10 minutes. A to- tal of 91 patients with biliary complications after liver transplantation were assigned to the DGT group （44 patients, including 6 difficult cannulation, 41 males and 3 females, 30 to 61 years） and the SCT group （47 patients, 41 males and 6 females, 33 to 56 years）. An extra 20-minute cannulation was performed on the two groups. Success rate, procedure time and complications were compared. Results CBD cannulation was successful in 36 （81.8%） patients of DGT group and 33 （70. 2% ） patients of SCT group, which was not different （ P 〉 0. 05 ）. The time of successful CBD cannulation in the DGT group （ 11.7 ± 3.2 minutes） was shorter than that in the SGT group （ 16. 8 ±2. 8 minutes, P 〈0. 05）. The incidence of post-ERCP hyperamy- lasemia had no difference in the two groups （P 〉 0. 05 ）. There were no serious complications like infection, hemorrhage or perforation in either group. Mild pancreatitis occurred in 2 cases in the SCT group, but none in DGT. Conclusion DGT is an effective and safe technique in patients with biliary complications after liv- er transplantation, with no more complications than the SCT group. It is recommended in difficult cannulation of common bile duct （CBD）.