不同电切模式对内镜下乳头括约肌切开术的影响

The effect of different cut modes on the endoscopic sphincterotomy

目的探讨不同电切模式对内镜下乳头括约肌切开术(endoscopic sphincterotomy,EST)治疗效果的影响。方法回顾性分析2020年1月至2021年12月在我科接受内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)治疗的患者资料,比较纯电切电流模式和Endocut模式下行EST治疗患者的临床治疗效果。结果自2020年1月至2021年12月共305例患者在我科接受了治疗性ERCP,206例患者行EST治疗,其中48例患者采用了普通高频电发生器的纯电切电流模式,158例患者采用了Endocut模式。纯电切模式组的拉链式切开发生率为10.42%(5/48),而Endocut组无拉链式切开发生。Endocut组EST大切开的比例25.95%(41/158)高于纯电切模式组10.42%(5/48)(P=0.0285),纯电切模式EST时的术中出血率22.92%(11/48)略高于Endocut模式12.03%(19/158),但无统计学差异(P=0.0991)。Endocut组高淀粉酶血症发生率41.14%(65/158)高于纯电切组22.92%(11/48)(P=0.0262)。而两组之间的胆管炎及急性胰腺炎的发生率无明显差异,两组均无穿孔及EST相关并发症导致死亡的病例。结论对于有着丰富ERCP经验的内镜医师,不同的电流切开模式并未对EST的治疗效果和安全性产生明显影响。

Objective To explore the effect of different cut modes on the therapeutic outcome of EST.Methods The data of patients undergoing ERCP from January 2020 to December 2021 in our department were retrospectively analyzed.The clinical outcomes of patients treated by EST with pure cut current mode were compared to that of patients treated by EST with Endocut mode.ResultsA total of 305 patients underwent therapeutic ERCP from January 2020 to December 2021 in our department,of which 206 patients were treated by EST with pure cut current mode in 48 patients and Endocut mode in 158 patients.Zip cutting was found in 10.42%(5/48)of patients in pure cut mode group,which did not occur in Endocut mode group.Large cutting rate was significantly higher in Endocut mode group(25.95%)compared with pure cut mode group(10.42%)(P=0.0285).Intraoperative bleeding was observed more frequently in pure cut mode group(22.92%)than Endocut mode group(12.03%)without significant difference(P=0.0991).The incidence of hyperamylasemia in Endocut mode group(41.14%)was significantly increased compared with pure cut mode group(22.92%)(P=0.0262).There was no difference in the incidence of cholangitis and acute pancreatitis between the two groups.No cases with perforation or death related to complications from EST were reported.Conclusion For an experienced ERCP endoscopist,different cut current modes did not significantly affect the outcomes and the safety of EST.