两种冲洗吸引方法用于SpyGlass胆道镜系统的对比研究

Comparison of two flushing suction methods in SpyGlass choledochoscopy system

目的评价改良的冲洗吸引方法在SpyGlass胆道镜操作时的应用效果。方法选取2013年2月至2015年1月73例SpyGlass胆道镜操作的患者，根据研究时间段分为A、B组。A组（n=34）在SpyGlass胆道镜检查时采用常规冲洗吸引方法，即负压管直接接于传送导管的活检孔道并结合十二指肠镜负压吸引；B组（n=39）在SpyGlass胆道检查时采用改良的冲洗吸引方法，即先将一次性注射器的外套连接于传送导管的活检孔道，再将负压管置于注射器的外套内，结合十二指肠镜负压吸引。记录SpyGlass胆道镜检查时患者的不良反应，SpyGlass传送导管置入胆胰管后获得I类图像的时间，SpyGlass总操作时间和术后并发症发生情况。结果SpyGlass胆道镜检查时患者出现的窦性心率减慢、心律不齐、躁动，A组分别为7例（20．6％）、5例（14．7％）、10例（29．4％），B组分别为1例（2．6％）、0例（0／39）、2例（5．1％），2组比较差异有统计学意义（P〈0．05）；获得清晰图像的时间，A组为6．2min，B组为3．3min（P〈0．05）；SpyGlass总操作时间，A组为24．9min，B组为16．8min（P〈0．05）；术后发生胆管炎的例数，A组为5例（14．7％），B组为1例（2．6％），2组术后胆管炎发生率比较差异有统计学意义（P〈0．05）。结论新的冲洗吸引方法在SpyGlass胆道镜操作时具有明显的优势。

Objective To evaluate the applicant effect of improved flushing suction method for SpyClass choledochoscope operation. Methods Seventy-three patients who underwent SpyGlass choledocho- scopy from February 2013 to January 2015 were enrolled. Negative pressure biopsy channel was used in group A（n=34） during conducting SpyGlass choledochoscopy with the tube directly connected to the conveying pipe and combined with duodenoscope suction.In group B （n = 39）, the biopsy channel of disposable syringe jacket was first connected to a delivery catheter, then the negative pressure pipe was put in the injector coat, combined with duodenoscope suction. Adverse reactions, the [ image acquisition time after the placement of SpyGlass delivery catheter to pancreaticobiliary duct, the total operation time, and the occurrence of compli- cations after operation were recorded. Results Sinus bradycardia, arrhythmia, agitation occurred in 7 cases （20.6%）, 5 cases （14.7%）, and 10 cases （29.4%） respectively in group A, those were 1 case （2. 6% ）, 0 case （0/39）, 2 cases （5. 1% ）respectively in group B with significant difference （P〈0. 05 ）. The time to acquire a clear image and the total operation time in group A were 6. 2 min and 24. 9 min, and 3.3 rain and 16. 8 minutes in B group with significant difference （P〈0. 05）, postoperative eholangitis oc- curred in 5 cases in group A（ 14. 7%）, 1 case （2. 6%） in group B with significant difference （P〈0. 05）. Conclusion New irrigation and suction method has obvious advantages in the SpyGlass system.