预置导丝在预防胆道镜诊疗中窦道重度形成不良并发症中的应用

Presetting guide wire to prevent severely inadequate sinus tract formation in choledochoscopy

目的:总结分析预置导丝方法在窦道重度形成不良高危患者行胆道镜诊疗中的临床意义和作用。方法:收集2014年1月~2018年12月行胆道镜诊疗的具有窦道形成不良的高危因素患者84例及其相关的临床资料,予以预置导丝方法完成诊疗,统计分析预置导丝方法在预防窦道重度形成不良并发症中的可行性、疗效及安全性。结果:共8例患者出现拔T管后胆道镜探查见窦道连续性不存在,其中7例成功沿预置导丝再次置管,另有1例在沿导丝进镜操作过程中导丝弹出,反复重置失败,最终接受急诊手术治疗。结论:在窦道重度形成不良的高危患者胆道镜检查中预置导丝能够安全、有效地提高拔T管胆漏后的再次置管成功率,从而降低患者的再手术率。

Objective:To summarize the clinical significance and effects by presetting guide wire to manage severely inadequate sinus tract formation in choledochoscopy in high-risk patients.Methods:Clinical data were collected in 84 high-risk patients undergone choledochoscopy between January 2014 and DecembeR2018.Guide wire was preset during examination and treatment.Feasibility,effects and safety in preventing severe pooRsinus tract related complications were statistically analyzed.Results:Severely inadequate sinus tract formation was seen in 8 patients in choledochoscopy afteRremoval of T-tube.Of the 8 cases,T-tube was successfully reset in 7 along the preset guide wire,failure insertion of the T-tube occurred in anotheRone due to unexpectedly shooting of the wire,though several attempts were made,this patient had to be referred to emergency surgery.Conclusion:Presetting guide wire can safely and effectively increase the successful rate of resetting tubes choledochoscopy in high-risk patients,and reduce severely inadequate sinus tract formation and incidence of re-operation.