双导丝技术与经胰管预切开技术在困难胆管插管中的应用

Comparison between double guidewire technique and transpancreatic sphincterotomy technique for difficult biliary cannulation

摘要:

目的 比较双导丝技术（DGT）与经胰管预切开技术（TPS）在困难胆管插管中的临床疗效及安全性。方法 回顾性纳入2014年1月至2016年1月在我院行经内镜逆行胰胆管造影术的连续患者，对于反复进入胰管的困难胆管插管患者，分别采用DGT或TPS辅助插管，比较两种技术的插管成功率、插管时间及并发症。结果 共237例困难胆管插管患者纳入研究，其中采用DGT插管者135例，TPS插管者102例。DGT与TPS的插管成功率分别为79.3%（107/135）和90.2%（92/102）（P=0.023），插管时间分别为（8.8±2.7）min和（4.7±1.3）min（P=0.017），总体并发症发生率分别为8.9%（12/135）和8.8%（9/102）（P=0.986）。结论 对于反复进入胰管的困难胆管插管患者，与DGT相比，TPS插管成功率高，耗时少且未增加并发症；对预切开操作技术熟练者，可首选TPS辅助插管。

Abstract:

Objective To compare the efficacy and safety of double guidewire technique (DGT) with the transpancreatic sphincterotomy (TPS) in cannulation of difficult biliary. Methods The data of patients undergoing endoscopic retrograde cholangiopancreatography from January 2014 to January 2016 in our hospital were retrospectively study. DGT or TPS was performed for patients with difficult biliary cannulation and frequent unintended pancreatic cannulation. The cannulation success rate, cannulation time and complications of DGT and TPS were compared. Results Data of 237 patients with difficult biliary cannulation were collected, including 135 using DGT and 102 using TPS. The cannulation success rate was 79.3% (107/135) in DGT and 90.2% (92/102) in TPS (P=0.023). The cannulation time was 8.8±2.7 min in DGT and 4.7±1.3 min in TPS (P=0.017). The overall incidence of complications was 8.9% (12/135) in DGT and 8.8% (9/102) in TPS (P=0.986). Conclusion For patients with difficult biliary cannulation, TPS has a higher successful rate, a shorter cannulation time, and a similar complication rate compared to DGT. Endoscopists with skilled TPS procedure could select TPS as a preferred method in difficult biliary cannulation.