CAJ | 학술논문

目的：比较双导丝技术（DGT）和经胰管预切开术（TPS）在插管困难型内镜逆行胰胆管造影术（ERCP）中应用的疗效和安全性。方法回顾性分析2008年1月至2013年7月在陕西省人民医院行 ERCP 治疗的613例患者，共71例患者胆管插管困难、导丝反复进入胰管。其中34例患者行DGT，37例患者行 TPS。采用χ2检验比较 DGT 组与 TPS 组插管成功率以及相关术后并发症如急性胰腺炎、高淀粉酶血症发生率，采用 t 检验比较 DGT 组与 TPS 组插管时间。结果 DGT 组插管成功率为88％（30/34），TPS 组插管成功率为87％（32/37），两者差异无统计学意义（χ2＝0．049，P ＝0．0954）；DGT组插管时间为（12．6±14．2）min，TPS 组插管时间为（13．4±15．9）min，两者差异无统计学意义（t ＝0．2084，P ＝0．8356）。DGT 组术后胰腺炎发生率为27％（9/34），高于 TPS 组术后胰腺炎发生率8％（3/37），且差异有统计学意义（χ2＝4．254，P ＝0．039）；DGT 组术后高淀粉酶血症发生率为32％（11/34），TPS 组术后高淀粉酶血症发生率为30％（11/37），两者差异无统计学意义（χ2＝0．057， P ＝0．811）。TPS 组1例患者发生十二指肠穿孔，而 DGT 组无一例患者发生十二指肠穿孔。结论当选择性胆管插管困难时，DGT 和 TPS 均可明显提高插管成功率，TPS 插管成功率略高于 DGT，DGT 术后胰腺炎发生率高于 TPS，TPS 则有并发十二指肠穿孔的风险。
목적：비교쌍도사기술（DGT）화경이관예절개술（TPS）재삽관곤난형내경역행이담관조영술（ERCP）중응용적료효화안전성。방법회고성분석2008년1월지2013년7월재합서성인민의원행 ERCP 치료적613례환자，공71례환자담관삽관곤난、도사반복진입이관。기중34례환자행DGT，37례환자행 TPS。채용χ2검험비교 DGT 조여 TPS 조삽관성공솔이급상관술후병발증여급성이선염、고정분매혈증발생솔，채용 t 검험비교 DGT 조여 TPS 조삽관시간。결과 DGT 조삽관성공솔위88％（30/34），TPS 조삽관성공솔위87％（32/37），량자차이무통계학의의（χ2＝0．049，P ＝0．0954）；DGT조삽관시간위（12．6±14．2）min，TPS 조삽관시간위（13．4±15．9）min，량자차이무통계학의의（t ＝0．2084，P ＝0．8356）。DGT 조술후이선염발생솔위27％（9/34），고우 TPS 조술후이선염발생솔8％（3/37），차차이유통계학의의（χ2＝4．254，P ＝0．039）；DGT 조술후고정분매혈증발생솔위32％（11/34），TPS 조술후고정분매혈증발생솔위30％（11/37），량자차이무통계학의의（χ2＝0．057， P ＝0．811）。TPS 조1례환자발생십이지장천공，이 DGT 조무일례환자발생십이지장천공。결론당선택성담관삽관곤난시，DGT 화 TPS 균가명현제고삽관성공솔，TPS 삽관성공솔략고우 DGT，DGT 술후이선염발생솔고우 TPS，TPS 칙유병발십이지장천공적풍험。
Objective To compare the outcomes between double-guidewire technique (DGT)and transpancreatic precut sphincterotomy (TPS ) in patients with difficult endoscopic retrograde cholangiopancreatography (ERCP).Methods This was a retrospective analysis on 61 3 patients treated using ERCP between January 2008 and July 201 3 in the Shanxi Provincial People′s Hospital.A total of 71 patients were picked out due to unavailable cystic duct cannula or repeated in-out pancreatic duct of the guide wire, with 34 patients treated using DGT and 37 patients using TPS.Chi-square test was used to compare the success rate of cannula and incidence rate of associated postoperative complications (such as acute pancreatitis,hyperamylasemia),t-test was used to compare between-group difference in the time of cannula. Results There were no significant statistical differences of between-group success rate of cannula (χ2 =0.049,P =0.095 4),with DGT group 88% (30 /34)and TPS group 87% (32 /37 ).And also no significant differences were found in time of cannula (t =0.208 4,P =0.835 6),with DGT group (1 2.6 ± 1 4.2)minutes and TPS group (1 3.4 ±1 5.9)minutes.The incidence rate of acute pancreatitis differed significantly between both groups (χ2 =4.254,P =0.039),with DGT group 27% (9 /34)significant higher than that in TPS group 8% (3 /37);while no significant differences were found in incidence rate of hyperamylasemia (χ2 =0.057,P =0.81 1 ),with DGT group 32% (1 1 /34)and TPS group 30% (1 1 /37). Furthermore,one case of duodenuml perforation occurred in TPS group,while none occurred in DGT group. Conclusion Facing unavailable selective pancreatic duct cannulation,both of DGT and TPS could significantly improve the success rate of cannula,with TPS a little higher than DGT,and the incidence rate of acute pancreatitis in DGT was higher than that in TPS,while the TPS might have potential risk of duodenuml perforation.