导丝引导插管对ERCP术后胰腺炎的影响

Effect of Guidewire Cannulation on Post-ERCP Pancreatitis

目的探讨内镜逆行胆胰管造影术(endoscopic retrograde cholangio-pancreatography,ERCP)中导丝进入胰管术后胰腺炎的发生率及置放胰管支架对术后胰腺炎的预防作用。方法回顾性分析2008年10月1日至2009年12月31日共计1 217例次ERCP术[均行内镜下括约肌切开术(endoscopic sphincterotomy,EST)]的临床资料,比较导丝进入胰管组(74例)、导丝进入胰管且放置胰管支架组(64例)及导丝未进入胰管组(1 079例)3组间ER-CP术后胰腺炎(post-ERCP pancreatitis,PEP)的发生率,分析导丝进入胰管对胰腺炎的影响及其支架对预防PEP的作用。结果导丝进入胰管组、导丝进入胰管且放置胰管支架组及导丝未进入胰管组PEP发生率分别为6.76%、6.25%、2.13%。导丝进入胰管组、导丝进入胰管且放置支架组PEP发生率显著高于导丝未进入胰管组(均P<0.05);导丝进入胰管组与导丝进入胰管且放置支架组PEP发生率比较差异无统计学意义(P>0.05)。结论导丝进入胰管是诱发ERCP术后胰腺炎的因素,而导丝进入胰管后放置胰管支架不减少术后胰腺炎的发生率。

Objective To investigate the incidence of post-ERCP pancreatitis after the insertion of guidewire into pancreatic duct and prophylactic effect of placing pancreatic duct stent on post- ERCP pancreatitis. Methods Data of 1 217 patients who underwent ERCP in our hospital from October 2008 to December 2009 were retrospectively investigated. The incidence of post-ERCP pancreatitis was compared among inserting guidewire into pancreatic duct group （group A, n =74）, placing pancreatic stent after inserting guidewire into pancreatic duct group（group B, n = 64） and without insertion of guidewire into pancreatic duct group（group C, n= 1 079）. The effect of inserting guidewire into pancreatic duct on pancreatitis and prophylactic effect of placing pancreat-ic duct stent were investigated. Results Compared with group C,the incidence of post-ERCP pan-creatitis significantly increased in group A and group B（6.76% and 6.25% vs 2.13% ,respective-ly） （P〈0. 05）. But there was no significant difference in the incidence of post-ERCP panereatitis between group A and group B（P〈0.05）. Conclusion The insertion of guidewire into pancreatic duct induces post-ERCP pancreatitis,but placing pancreatic duct stent after the insertion of guidewire in pancreatic duct can not prevent post-ERCP pancreatitis.