临时性胰管支架在ERCP胆管插管困难病例中的应用价值

The Clinical Applicative Value of Temporary Pancreatic Stents in Difficult Biliary Cannulation of ERCP

目的探讨通过留置临时性胰管支架选择性胆管插管对提高胆管插管困难者的造影成功率及并发症发生率。方法内镜下逆行性胰胆管造影(ERCP)以胆管插管为目的时,因为十二指肠乳头偏位、柔软易移动、胆总管下端过度弯曲、乳头狭窄、憩室旁乳头等存在一些胆管插管困难病例,导丝反复进入胰管,且双导丝技术2～3次后导丝仍不能进入胆管者,我们采用在胰管内临时留置胰管支架,再试行胆管插管造影或预切开。结果 43例留置胰管支架者,42例胆管插管造影成功,1例失败,1例轻症胰腺炎发生。结论 ERCP选择性胆管插管困难时采用临时胰管支架能提高成功率,可能降低胰腺炎发生率。

Objective To evaluate the effect and complication of selective biliary cannulation by using temporary pan- creatic stents for overcoming the difficulty on biliary carmulation. Methods In difficult cases for deep biliary cannulation, such as papilla deflection, and easy movement, acute angulation of the distal bile duct, papilla stricture, Juxta- papillary duodenal di- verticum, guide-wire entered pancreatic duct repeatedly, and guide-wire didn＇t entered pancreatic duct after 2 ~ 3 double-wire technique. We attempted inserting a pancreatic stent into the pancreatic duct to facilitate deeps elective biliary eannulation or pre-cut. Results 42 of 43 patients who were inserted pancreatic stents had successful selective biliary cannulation, one pant- ient failed, one case＇ complicated with mild pancreatis. Conclusion In difficult bile duct eannulation during ERCP, indwelling temporarily pancreatic stents may perhaps reduce the rate of complication of post-ERCP pancreatits.