小儿经内镜逆行胰胆管造影术插管的经验及影响因素分析

Experience and influencing factors of endoscopic retrograde cholangiopancreatography intubation in children

目的探讨小儿经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)插管技巧,分析影响插管的因素。方法回顾性分析2016年1月—2020年6月间于上海交通大学医学院附属新华医院完成的小儿和成人ERCP操作各90例,统计其解剖相关数据、插管时间、镜下插管措施等数据,比较小儿与成人的十二指肠乳头区域解剖差异,分析影响小儿ERCP插管时间因素。结果小儿组成功插管88例,成功率97.8%;成人组成功插管90例,成功率100.0%。小儿组插管时间(187±67)s,成人组插管时间(247±86)s,二者差异有统计学意义(t=5.220,P<0.001)。十二指肠直径小儿患者(3.38±1.57)cm,成人患者(5.94±1.87)cm,差异有统计学意义(t=9.832,P<0.001)。十二指肠球部至乳头水平的距离小儿患者(2.44±1.15)cm,成人患者(4.22±1.43)cm,差异有统计学意义(t=9.077,P<0.001)。小儿患者乳头形态半球型居多[扁平26.1%(23/88)、半球51.1%(45/88)、圆柱22.7%(20/88)],而成人患者圆柱形居多[扁平9.1%(8/88)、半球23.9%(21/88)、圆柱67.0%(59/88)]。影响小儿ERCP插管时间的因素包括乳头形态、乳头硬度、视野位置、十二指肠球降交界处至乳头距离、乳头与内镜的距离、切开刀挑起程度等。结论ERCP操作时,十二指肠乳头更短、更硬及乳头朝向正常者,其插管时间更短,这些指标是插管的有利因素。

Objective To report pediatric endoscopic retrograde cholangiopancreatography(ERCP)intubation techniques and to analyze the influencing factors of pediatric ERCP in China.Methods Retrospective analysis was performed on 90 cases of pediatric and adult ERCP operations respectively at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2016 to June 2020.The anatomic data,intubation time,and endoscopic intubation measures were reviewed.The anatomic differences in duodenal papilla between the children and adults were analyzed to find the factors affecting ERCP intubation time in children.Results There were 88 cases of successful infantile intubation with the success rate of 97.8%,and 90 cases of successful adult intubation with the success rate of 100.0%.The intubation time in the pediatric group was 187±67 s,and that in the adult group was 247±86 s with significant difference(t=5.220,P<0.001).The duodenal diameter of pediatric patients was 3.38±1.57 cm,and that of adult patients was 5.94±1.87 cm with significant difference(t=9.832,P<0.001).The horizontal distance from the duodenal bulb to the papilla in pediatric patients was 2.44±1.15 cm,which was significantly shorter than 4.22±1.43 cm in adult patients(t=9.077,P<0.001).Most duodenal papillae in children were hemispherical[flat 26.1%(23/88),hemispherical 51.1%(45/88),cylindrical 22.7%(20/88)],while most of those in the adult patients were cylindrical[flat 9.1%(8/88),hemispherical 23.9%(21/88),cylindrical 67.0%(59/88)].The factors influencing the intubation time of ERCP in children by univariate analysis included the shape of duodenal papilla,duodenal papilla hardness,visual region,distance from junction of duodenal bulb and descending part to duodenal papilla,distance from duodenal papilla to endoscope,and degree of incising.Conclusion Shorter and stiffer duodenal papillae in children with normal papilla orientation are associated with shorter intubation time.These indicators are favorable factors for intubation.