CAJ | 학술논문

目的研究双导丝(DTG)法在胆总管深插管中的应用情况.方法选择89例患者,诊断为壶腹部肿瘤的患者被剔除.在行逆行性胰胆管造影术(ERCP)时,先用常规导丝引导切开刀或导管选择性胆总管插管.如导丝3次进入胰管后,则保留胰管导丝,重新从活检钳道插入第2根导丝进行选择性胆总管插管.根据导丝的走行及切开刀或导管抽吸胆汁证实选择性胆总管插管成功.双导丝插管难度评价标准:第2根导丝在1～3次内成功进入胆总管为容易;4～6次内成功为中等难度;7～10次以内成功为难度;如果10次内插管不成功为插管失败.并比较双导丝插管方法或常规插管方法ERCP术后胰腺炎的发生率.结果 89例患者中,常规插管方法进行胆总管深插管的成功率约为67.4%(60/89).5例患者(5.6%,5/89)导丝不能进入胆总或者胰管,其余24例(27.0%,24/89)采用DGT法.在DGT法插管中,13例(54.2%,13/24)为容易DGT插管,6例(25.0%,6/24)为中等难度DGT插管,4例(16.7%,4/24)为难度的DGT插管,只有1例(4.1%,1/24)患者虽然经过调整角度导丝仍然进入胰管而改用PSP法.在常规方法进行胆总深插管的患者中,4例(6.7%,4/60)例患者有术后胰腺炎,而DGT法中有2例(8.7%,2/23),两组间差异无统计学意义(P＞0.05).结论在ERCP的操作中,DGT法是常规胆总管深插管失败后比较可靠的一种选择胆总管深插管方法.DGT法不会提高术后胰腺炎的发生率,容易掌握,可推荐作为ERCP术常规插管方法.
목적 연구쌍도사(DTG)법재담총관심삽관중적응용정황.방법 선택89례환자,진단위호복부종류적환자피척제.재행역행성이담관조영술(ERCP)시,선용상규도사인도절개도혹도관선택성담총관삽관.여도사3차진입이관후,칙보류이관도사,중신종활검겸도삽입제2근도사진행선택성담총관삽관.근거도사적주행급절개도혹도관추흡담즙증실선택성담총관삽관성공.쌍도사삽관난도평개표준:제2근도사재1～3차내성공진입담총관위용역;4～6차내성공위중등난도;7～10차이내성공위난도;여과10차내삽관불성공위삽관실패.병비교쌍도사삽관방법혹상규삽관방법ERCP술후이선염적발생솔.결과 89례환자중,상규삽관방법진행담총관심삽관적성공솔약위67.4%(60/89).5례환자(5.6%,5/89)도사불능진입담총혹자이관,기여24례(27.0%,24/89)채용DGT법.재DGT법삽관중,13례(54.2%,13/24)위용역DGT삽관,6례(25.0%,6/24)위중등난도DGT삽관,4례(16.7%,4/24)위난도적DGT삽관,지유1례(4.1%,1/24)환자수연경과조정각도도사잉연진입이관이개용PSP법.재상규방법진행담총심삽관적환자중,4례(6.7%,4/60)례환자유술후이선염,이DGT법중유2례(8.7%,2/23),량조간차이무통계학의의(P＞0.05).결론 재ERCP적조작중,DGT법시상규담총관심삽관실패후비교가고적일충선택담총관심삽관방법.DGT법불회제고술후이선염적발생솔,용역장악,가추천작위ERCP술상규삽관방법.
Objective To evaluate the application of double guidewire technique (DGT) in deep cannulation of bile duct. Methods Eighty-nine patients were enrolled, patients diagnosed with ampullary tumors were excluded from this research. During endoscopic retrograde cholangiopancreatography (ERCP),patients underwent knife or catheter selective cannulation of bile duct guided by routine guidewire. Pancreatic duct guidewire was retained and a second guidewire was inserted through biopsy forcep canal if the guidewire unintendedly entered pancreatic duct for 3 times. Selective cannulation of the common bile duct was verified to be successfully performed according to the course of guidewire and bile aspiration with knife or catheter.The difficulty of DGT was assessed by number of attempts before successful bile duct cannulation with the second guidewire and rated as follows: easy = one to three attempts; moderately difficult = four to six attempts; difficult = seven to ten attempts; failure = more than 10 attempts but still unsuccessful. Incidences of post-ERCP pancreatitis by DGT and routine cannulation were compared. Results The success rate of deep cannulation of bile duct in routine ERCP procedures was 67.4% (60/89), and the guidewires could not be inserted into bile duct or pancreatic duct in 5 patients (5.6%, 5/89). Twenty-four patients (27.0%,24/89) underwent DGT. In the DGT patients, cannulation was easy in 13 patients (54.2%, 3/24) ,moderately difficult in 6 (25.0%, 6/24), and difficult in 4 (16.7%, 4/24), respectively. Only one patient (4.1%, 1/24) was converted to PSP since the guidewire constantly entered pancreatic duct despite angle adjustment. Postoperative pancreatitis was observed in 4 routine ERCP procedure cases (6.7%, 4/60) and 2 DGT cases (8.7% , 2/23) , and there was no significant difference between the two groups (P＞0.05).Conclusion s DGT appears to be a reliable method for selective deep bile duct cannulation after failed routine catheterization during ERCP. The easy-to-use DGT is not associated with increased post-ERCP pancreatitis, and therefore can be recommended as a routine method for ERCP deep bile duct cannulation.