两种乳头插管技术在内镜逆行胰胆管造影术中的应用研究

Application of two methods of nipple intubation in ERCP

目的探讨单人操作导丝乳头插管法与双人操作导丝乳头插管法在内镜逆行胰胆管造影术(ERCP)中的应用效果。方法回顾性分析2019年2月-2021年2月因胆胰疾病行ERCP治疗的445例患者的临床资料,比较两种乳头插管技术在ERCP中的插管成功率和术后并发症发生情况,并初步分析术后并发高淀粉酶血症的危险因素。结果插管总成功率为97.3%。其中,单人插管组成功率为97.5%,双人插管组成功率为97.1%,两组患者术后并发症比较,差异无统计学意义(P=0.782)。术后发生胰腺炎22例(4.9%),高淀粉酶血症105例(23.6%),两组患者术后并发症比较,差异无统计学意义(P>0.05)。单人插管组和双人操作组插管时间为(7.15±0.48)和(10.70±0.71)min,ERCP完成时间为(19.24±1.26)和(23.11±1.64)min,住院时间中位数为9.0和11.0 d,单人插管组均短于双人插管组,差异有统计学意义(P<0.05)。结论两种乳头插管技术ERCP插管成功率和术后并发症发生率无明显差异,单人插管技术因不需要助手密切配合,有利于缩短插管时间,减少导丝进入胰管频率和乳头损伤,降低术后并发症发生率,从而缩短住院时间。值得临床推广应用。

Objective To investigate the effect of single-person and two-person guidewire papillary intubation in endoscopic retrograde cholangiopancreatography(ERCP).Methods General data of 445 patients who underwent ERCP treatment for pancreatic biliary diseases from February 2019 to February 2021 were collected to compare the success rate of ERCP intubation and postoperative complications between the two methods,then analyze the influencing factors of hyperamylasemia.Results The overall success rate of intubation was 97.3%,of which the rate of single intubation was 97.5%and that of double intubation was 97.1%,there was no significant difference between the two groups(P=0.782).Pancreatitis occurred in 22 cases(4.9%)and hyperamylasemia in 105 cases(23.6%),there was no significant difference in the incidence of postoperative complications between the two methods of intubation(P>0.05).However,the time of intubation[(7.15±0.48)min vs(10.70±0.71)min],ERCP completion time[(19.24±1.26)min vs(23.11±1.64)min]and hospital stay(9.0 d vs 11.0 d)in the single-person intubation group were significantly faster than those in the two-person operation group,there were statistically significant difference(P<0.05).Conclusion There is no significant difference in the success rate of ERCP intubation and the incidence of postoperative complications between the two methods of nipple intubation.Single-person intubation technique is beneficial to shorten the intubation time,reduce the number of guidewire entering the pancreatic duct,reduce nipple injury,reduce the incidence of postoperative complications,and thus reduce the length of hospital stay because it does not require close cooperation of the assistant.