双导丝技术联合胰管支架预防经内镜逆行胰胆管造影术后急性胰腺炎的初步研究

A preliminary study of double guidewire technique combined with pancreatic duct stenting in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis

初步探讨双导丝技术联合胰管支架对经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)后急性胰腺炎(post-ERCP pancreatitis,PEP)的预防效果。采用随机数字表法,将纳入的拟行ERCP的胆总管结石患者分为试验组和对照组,试验组采用双导丝技术联合胰管支架,对照组采用传统胆管选择性插管,对比分析两组插管时间、PEP及术后高淀粉酶血症发生率和术中、术后出血情况。2016年1月—2018年12月共入组80例患者,试验组40例,对照组39例。试验组插管时间为(384±102)s,2例发生高淀粉酶血症,无术后胰腺炎、术中术后出血发生。对照组插管时间为(427±115)s,6例发生高淀粉酶血症,3例发生术后胰腺炎,1例发生术中出血。试验组和对照组PEP发生率分别为0和7.7%(3/39),术后高淀粉酶血症发生率分别为5.0%(2/40)和15.4%(6/39),差异均有统计学意义(P均<0.05)。双导丝技术联合胰管支架可以成功进行胆管选择性插管,同时有效预防PEP发生。

To study the preventive effects of double guidewire technique combined with pancreatic duct stenting in preventing post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP).Patients receiving ERCP were divided into the treatment group and the control group by random number table.In the treatment group,double guidewire technique combined with pancreatic duct stenting was applied.In the control group,selective biliary intubation was applied in the conventional way.The intubation time,PEP,hyperamylasemia and bleeding incidence were analyzed between the two groups.A total of 80 patients were enrolled in this study from January 2016 to December 2018.There were 40 cases in the treatment group and 39 cases in the control group.In the treatment group,the mean intubation time was 384±102 seconds.No PEP or bleeding during and after the operation occurred,but hyperamylasemia occurred in 2 cases.In the control group,the mean intubation time was 427±115 seconds.Hyperamylasemia occurred in 6 cases,PEP occurred in 3 cases,and 1 case of intraoperative bleeding happened in the control group.The incidence of PEP[0 VS 7.7%(3/39)]and hyperamylasemia[5.0%(2/40)VS 15.4%(6/39)]were lower in the treatment group(both P<0.05).Double guidewire technique combined with pancreatic duct stenting can successfully perform selective bile duct intubation and effectively prevent PEP.