双导丝术与早期经胰管乳头预切开术在困难性胆管插管内镜逆行胰胆管造影中的应用

Application of double guidewire technique and early transpancreatic precut sphincterotomy in difficult biliary cannulation during endoscopic retrograde cholangiopancreatography

目的探讨双导丝术与早期经胰管乳头预切开术在困难性胆管插管内镜逆行胰胆管造影(ERCP)中的应用,为临床治疗策略的选择提供理论依据。方法选取2016年1月到2019年12月于宿迁市第一人民医院就诊的104例困难性胆管插管患者,根据患者的插管方式,将以双导丝术插管的42例患者为A组,以早期经胰管乳头括约肌预切开术插管的23例患者为B组,以常规插管法的39例患者为C组。对比3组患者的插管成功率;分析比较三组患者术后并发症的发生情况。结果B组插管成功率最高,为95.7%,其次为A组的85.7%,C组仅为53.9%,A组和B组的插管成功率均显著高于C组(均P<0.05);A组和B组的插管成功率对比,差异无统计学意义(P>0.05)。A、B、C三组患者术后并发症的发生率分别为14.3%、26.1%、20.5%,A组最低,但三组两两对比,差异均无统计学意义(均P>0.05)。结论双导丝术与早期经胰管乳头括约肌预切开术均可显著提高ERCP困难性胆管插管的成功率,且术后并发症发生风险低,安全性良好。

Objective To explore the application of double guidewire and early transpancreatic precut sphincterotomy in difficult biliary cannulation during endoscopic retrograde cholangiopancreatography(ERCP),to provide a theoretical basis for the selection of clinical treatment strategies.Methods A total of 104 patients with difficult biliary cannulation treated at the First People's Hospital of Suqian City from January 2016 to December 2019 were selected.According to the cannulation methods used,42 patients who were cannulated with double guidewire were included in group A,23 patients who were cannulated by early transpancreatic precut sphincterotomy were included in group B,and 39 patients who underwent conventional cannulation were included in group C.The success rate of intubation in the three groups was compared,and the incidence of postoperative complications in the three groups was analyzed.Results Group B had the highest success rate(95.7%),followed by group A(85.7%)and group C(53.9%).The success rates of intubation in groups A and B were both significantly higher than that in group C(P<0.05);there was no significant difference in the success rate of intubation between groups A and B(P>0.05).The incidence of postoperative complications in groups A,B,and C was 14.3%,26.1%,and 20.5%,respectively;there was no significant differences in the incidence of postoperative complications among the three groups(P>0.05).Conclusion Both double guidewire surgery and early transpancreatic precut sphincterotomy can significantly improve the success rate of difficult biliary cannulation during ERCP,and have a low risk of postoperative complications and good safety.