预切开窗后插管失败再次胆管插管的体会

A second ERCP for the failure of pre-cut ERCP

目的探讨对经内镜逆行胰胆管造影术（ERCP）预切开或开窗方法后胆管插管失败者，行第2次ERCP操作的价值。方法167例患者术前拟诊胆总管结石和／或良性乳头狭窄109例，胆胰占位性病变58例。第一次ERCP标准胆管插管均在20min以上，不能成功后作预切开或开窗术，再反复试插后仍未能成功；3～5d后，再次行ERCP；第2次ERCP大多数患者按胆胰管合流水平位、前位和后位顺序插管。结果133例（79．6％）经第2次ERCP获得成功，其中水平位插管成功85例，前位插管成功36例，后位插管成功12例。插管成功后顺利完成了内镜的相应治疗。1例发生乳头穿孔伴后腹膜感染，1例并发重症胰腺炎形成胰周脓肿，均经腹腔穿刺引流方法治愈。结论经过更缜密的准备，掌控好胆管插管技巧，再次ERCP仍有较高的成功率。

Objective To study the therapeutic value of a second ERCP for the patients with failure of pre-cut ERCP. Methods A total of 167 cases of pre-cut ERCP failure were recruited to the study, among which 109 cases were diagnosed as common bile duct stones and/or benign papillary stenosis, and 58 cases as biliopancreatic lesion. ERCP failed with standard intubation for more than 20 minutes, even with pre-cut or fenestration. A second ERCP was preformed after rest of 3-5 days. The position sequence of intubation for most patients was horizontal, the front and rear. Results The success rate was 79. 6% （ 133 cases） for the patients with a second ERCP, 85 patients received the procedures via the horizontal intubation, 36 via anteri- or, and 12 via posterior intubation. The treatments were performed after successful completion of the endo- scopic cannulation. One patient had retroperitoneal infection with duodenal perforation, another patient had severe pancreatitis, who were cured by the intervention methods. Conclusion The success rate of a second ERCP is high with proficient intubation skills.