双导丝法在困难ERCP中的应用及护理配合

The Application of Double-guidewire Canulation in Difficult Binary Canulation and Its Corresponding Nursing Coordination

目的:观察双导丝插管技术在ERCP选择性胆管插管困难中的应用效果及护理配合要点。方法:选择行ERCP治疗的患者,对常规导丝引导切开刀选择性胆总管插管失败且导丝3次进入胰管者,保留胰管导丝,再次用第2根导丝引导切开刀进行选择性胆总管插管,并比较双导丝法与常规插管方法的成功率及术后胰腺炎发生率。结果:73例治疗性ERCP中,常规插管成功51例,22例为插管困难性ERCP,对导丝3次进入胰管者采用双导丝技术行胆管深插管有16例,成功15例,两组间差异有统计学意义(P<0.05);在常规插管方法患者中有2例术后发生胰腺炎,在双导丝方法中也有2例发生术后胰腺炎,两组间差异无统计学意义(P>0.05)。结论:双导丝插管是常规胆总管深插管失败后比较可靠的一种补偿方法,可以提高困难性ERCP诊治的成功率,术中娴熟的护理配合技巧是保证双导丝插管法行困难ERCP成功的关键。

Objective：To observe the effect of the double-guidewire technique in difficult biliary cannulation and it＇s nursing methods.Method.＇a catheter, pre-inserted with a guidewire was used for standard binary canulatio^pa- tients who failed standard binary canulation within 10 min and guidewire were inserted into pancreatic ducts for 3 times, were defined difficult binary canulation.Then a guide was left in pancreatic duct.catheter, pre-inserted with another guidewire, was used for the second binary canulation.And compare the successful rate and post ERCP pan- creatitis rate of the two canulation methods.Result：of the total 73 patients,51 patients were successful by standard canulation,and 22 patient were difficult canulation cases.In 22 difficult patients,15 cases were canulated successful- ly by double-guidewire technique.The successful rate of canulation were significant different between two groups （P〈0.O5）.Difference of the post ERCP pancreatitis rate between two groups was not significant （P〉O.OS）.Conclusion： double-guidewire technique can improve the successful rate of ERCP canulation when standard canulation failed.