Roux-en-Y吻合术后内镜逆行胰胆管造影术选择性插管的方法对比(含视频)

A comparative study of selective intubation methods for endoscopic retrograde cholangiopancreatography after Roux-en-Y anastomosis(with video)

目的比较Roux-en-Y吻合术后采用双人操作法和三人操作法行内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)的安全性和有效性。方法将杭州市第一人民医院消化内科2021年1月至2022年9月进镜成功、找到十二指肠乳头的31例Roux-en-Y吻合术后胆总管结石患者纳入研究对象。采用回顾性研究的方法,2021年1—12月采用双人操作法(即一名操作医师和一名助手完成选择性插管操作)行ERCP的17例患者纳入A组,2022年1—9月采用三人操作法(即一名操作医师和两名助手完成选择性插管操作)行ERCP的14例患者纳入B组。比较两组插管成功率、插管时间和并发症发生率。结果所有入组患者插管成功率为90.32%(28/31),其中A组插管成功率为82.35%(14/17),B组插管成功率为100.00%(14/14),两组患者插管成功率比较差异无统计学意义(P=0.232)。B组插管时间明显低于A组[(42.89±6.57)min比(61.02±9.23)min],差异有统计学意义(t=5.77,P<0.001)。所有入组患者ERCP术后并发症发生率为16.13%(5/31),A组和B组分别为17.65%(3/17)和14.29%(2/14),差异无统计学意义(P=1.000)。结论对于Roux-en-Y吻合术后并发胆总管结石行ERCP患者,两种方法在插管成功率和手术相关并发症发生率方面相当,但在操作时间方面三人操作法具有明显优势。

Objective To compare the safety and efficacy of two-person and three-person operation of endoscopic retrograde cholangiopancreatography(ERCP)after Roux-en-Y anastomosis.Methods A total of 31 cases of bile duct stones where endoscopic access was successful and papilla was detected after Roux-en-Y anastomosis in Hangzhou First People's Hospital from January 2021 to September 2022 were recruited.Based on the retrospective study,17 patients with the two-person operation(an operator and an assistant completed selective intubation)were included in group A from January to December 2021,and 14 patients with the three-person operation(an operator and two assistants completed the selective intubation)from January to September 2022 were included in group B.The success rate,the time of intubation,and complication incidence of the two groups were compared.Results The intubation success rate of all enrolled patients was 90.32%(28/31).There was no significant difference in the intubation success rate between group A and group B[82.35%(14/17)VS 100.00%(14/14),P=0.232].The intubation time in group B was significantly less than that of group A(42.89±6.57 min VS 61.02±9.23 min)with significant difference(t=5.77,P<0.001).The incidence of postoperative complication of ERCP in all enrolled patients was 16.13%(5/31).There was no significant difference in the postoperative complication incidence between group A and group B[17.65%(3/17)VS 14.29%(2/14),P=1.000].Conclusion For patients undergoing ERCP after Roux-en-Y anastomosis,the two methods were not statistically different in terms of the intubation success rate and the incidence of procedure-related complications.But three-person operation shows clear advantage in terms of operation time.