CAJ | 학술논문

目的探讨应用导丝超选胆管技术在减少ERCP术后相关胰腺炎中的价值.方法随机抽取术者1998-2001年间以乳头直接插入法行诊断性及治疗性ERCP术病人共78例,及2007-2008年间应用导丝超选技术行ERCP术病人112例,回顾性对比研究了两组插管成功率、胰管显影率,以及ERCP术后血淀粉酶的动态变化、相关胰腺炎的发生情况,并进行胰管显影分级与胰腺炎并发症之间的单因素相关分析.结果乳头直接插入法的胆管插管成功率仅42.30 %(33/78例),约61.53%(16/26例)的病人因插管失败,不能进一步行ERCP相关治疗;而近年采用导丝超选胆管技术显著提高了插管成功率94.64%(106/112例,P<0.01).前后两组术中胰管显影率分别为58.97 %(46/78例)及8.04%(9/112例)(P<0.01);术后相关胰腺炎发生率分别为21.79%(17/78例)及3.57%(4/112例)(P<0.01),其中直接插管组有3例发生重症胰腺炎,导丝超选组无一例发生重症胰腺炎;两组ERCP术后高淀粉酶血症发生率分别为65.38%(51/78例)及61.61%(69/112例)(P>0.05).胰管显影程度与ERCP术后胰腺炎的发生之间有显著的正相关性(P<0.01).结论借助导丝引导的胆管超选技术明显提高了插管成功率,显著降低了ERCP术后相关胰腺炎并发症,并可降低操作过程中胰管的显影率;胰管显影分级可预测ERCP术后胰腺炎的发生,是导致其发生的重要的但非单一因素.
목적 탐토응용도사초선담관기술재감소ERCP술후상관이선염중적개치.방법 수궤추취술자1998-2001년간이유두직접삽입법행진단성급치료성ERCP술병인공78례,급2007-2008년간응용도사초선기술행ERCP술병인112례,회고성대비연구료량조삽관성공솔、이관현영솔,이급ERCP술후혈정분매적동태변화、상관이선염적발생정황,병진행이관현영분급여이선염병발증지간적단인소상관분석.결과 유두직접삽입법적담관삽관성공솔부42.30 %(33/78례),약61.53%(16/26례)적병인인삽관실패,불능진일보행ERCP상관치료;이근년채용도사초선담관기술현저제고료삽관성공솔94.64%(106/112례,P<0.01).전후량조술중이관현영솔분별위58.97 %(46/78례)급8.04%(9/112례)(P<0.01);술후상관이선염발생솔분별위21.79%(17/78례)급3.57%(4/112례)(P<0.01),기중직접삽관조유3례발생중증이선염,도사초선조무일례발생중증이선염;량조ERCP술후고정분매혈증발생솔분별위65.38%(51/78례)급61.61%(69/112례)(P>0.05).이관현영정도여ERCP술후이선염적발생지간유현저적정상관성(P<0.01).결론 차조도사인도적담관초선기술명현제고료삽관성공솔,현저강저료ERCP술후상관이선염병발증,병가강저조작과정중이관적현영솔;이관현영분급가예측ERCP술후이선염적발생,시도치기발생적중요적단비단일인소.
Objective To determine if using a soft-tipped guidewire to cannulate the common bile duct may ameliorate development of PEP(post-ERCP pancreatitis)and facilitate cannulation of the CBD(common bile duct).Methods A total of 78 patients treated treateed in our hospital underwent ERCP through conventional direct cannulation(52 diagnostic ERCPs,26 therapeutics ERCPs)from 1998 to 2001 were randomly selected as group A while 112 patients underwent ERCP through guide wire-directed cannulation(21 diagnostic ERCPs,91 therapeutics ERCPs)from 2007 to 2008 as group B.Then we retrospectively studied and compared the following parameters between the two groups:1)Success rate of biliary access;2)visualization rate of pancreatic duct;3)the level of serum amylase,severity of abdominal pain and the rate of PEP.Meanwhile,the correlation between grading of pancreatic duct visualization and PEP was analyzed.Results The success rate of biliary access of the guidewire group(106/112 cases)was significantly greater than the conventional group(33/78 cases)(94.64%vs.42.30%,P<0.01).In group A,about61.53%(16/26)of the 26 cases could not continue the next therapeutics ERCP because of unsucceasful carmulation. The visualization rate of pancreatic duct of group A and B were 58.97%(46/78 cases)and 8.04%(9/112 cases)(P<0.01) respectively.On occurrence rate of PEP,group A(17/78 cases)was significantly higher than group B(4/112 cases)(21.79% vs.3.57%,P<0.01),and severe pancreatitis occurred in 3 patients in conventional group.However,there was no severe pancreatitis in the guide wire group.There were no significant differences (P>0.05) in terms of the rate of hyperamylasemia between the two groups.The significant correlation was found between the grading of pancreatic duct visualization and the occurrence of PEP.Condusion Guidewire-directed selective access to the bile duct lowers likdihood of PEP by facilitating cannulation and lowering the visualization rate of pancreatic duct.The occurrence of PEP could be predicted by the grading of pancreatic duct visualization,which is a very important but not the unique factor leading to PEP.