导丝超选胆管插入法与乳头直接插入法对ERCP术后并发症的影响比较

Comparison of post-ERCP complications between patients using guidewire ultraelection duct insertion versus those using direct papillary insertion

目的:比较导丝超选胆管技术与乳头直接插入法对内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)术后并发症的影响.方法:选取我院需要ERCP手术的患者91例,根据导丝插入方法不同分为导丝超选胆管插入法44例和乳头直接插入法47例,对比两组患者的手术成功率、胰管显影率、术后胰腺炎(post-ERCP pancreatitis,PEP)发生率及手术前后血清淀粉酶的变化情况.结果:乳头直接插入法手术成功率为42.02%,胰管显影率为51.07%,PEP发生率为17.02%;导丝超选技术手术成功率为90.91%,胰管显影率为6.82%,PEP发生率为4.55%.与导丝超选相比,乳头直接插入法手术成率、PEP发生率明显较低,胰管显影率较高,差异均有统计学意义(P<0.01).与手术前比较,所有患者术后6、24 h血清淀粉酶均升高,差异有统计学意义(P<0.05).手术成功的患者中,两种方法48h血清淀粉酶较术后24 h降低,差异有统计学意义(P<0.05);导丝超选法术后48 h血清淀粉酶较乳头直接插入法降低,差异有统计学意义(P<0.05).结论:导丝超选胆管技术插入法手术成功率高,胰管显影率及PEP发生率低,相对于传统的乳头直接插入法具有很大优势,值得推广.

AIM： To explore the impact of guidewire ultraelection duct insertion versus direct papillary insertion on post-endoscopic retrograde cholangiopancreatography （ERCP） complications. METHODS： Ninety-one patients who underwent ERCP at our hospital were involved. According to the way the guide wire was inserted, they were divided into two groups： those using the guidewire ultra-election duct insertion （44 cases） and those using direct papillary insertion （47 cases）. The surgical success rate, pancreatic duct visualization rate, post-ERCP pancreatitis （PEP） incidence and postoperative changes in serum amylase were compared between the two groups. RESULTS： Surgical success rate, pancreatic duct visualization rate and PEP incidence in the direct papillary insertion group were 42.02%, 51.07% and 17.02%, respectively. The corresponding values in the guidewire ultra-election bile duct insertion group were 90.91%, 6.82% and 4.55%. Compared with the guidewire ultraelection insertion group, the direct papillary insertion group had significantly lower surgical success rate and PEP incidence but higher pancreatic duct visualization rate （P 〈 0.01 for all）. Serum levels of amylase at 6 and 24 h were significantly increased in all patients compared with preoperative values （P 〈 0.05 for all）. Serum amylase levels at 48 h in both groups were significantly lower than those at 24 in all patients with successful surgery （P 〈 0.05）. Serum levels of amylase at 48 h in the guidewire ultraelection duct insertion group was significantly lower than that in the direct papillary insertion group （P 〈 0.05）. CONCLUSION： Compared with the traditional direct papillary insertion method, guidewire ultra-election bile duct insertion technique has huge advantages in terms of higher surgical success rate and lower pancreatic duct visualization rate and incidence of PEP.