双导丝技术在导丝所致十二指肠乳头穿孔中的应用价值

Clinical value of double guidewire technique for perforation of duodenal papilla by guidewire in endoscopic retrograde cholangiopancreatography

摘要:

目的 评价ERCP插管过程中导丝所致十二指肠乳头穿孔时使用双导丝技术胆管插管的效果及安全性。 方法 2008年1月至2016年9月，57例ERCP插管过程中导丝所致十二指肠乳头穿孔病例纳入回顾性研究，其中采用双导丝技术行胆管插管30例（双导丝组）、传统方法继续胆管插管27例（标准组），总结并比较2组的插管成功率、插管时间及并发症发生率。 结果 双导丝组插管成功率[96.7%（29/30）]明显高于标准组[74.1%（20/27），χ2=5.545，P=0.019]，平均插管时间[（21.8±7.8）min]明显短于标准组[（40.7±8.4）min，t=8.076，P=0.000]，并发症发生率[13.3%（4/30）]与标准组[11.1%（3/27），χ2=0.292，P=0.596]相近，均为术后高淀粉酶血症。 结论 ERCP插管过程中导丝所致十二指肠乳头穿孔时使用双导丝技术胆管插管安全且有效，较之传统方法具有插管成功率更高且省时的优势。

Abstract:

Objective To evaluate the efficacy and safety of double guidewire technique inperforation of duodenal papilla caused by guide wire during endoscopic retrograde cholangiopancreatography(ERCP ) intubation. Methods A retrospective analysis was performed on data of 57 patients whoseduodenal papilla were perforated by guidewire in ERCP from January 2008 to September 2016. Among the 57 patients, 30 patients were cannulated with double guidewire technique ( double guidewire group) and 27patients were performed with traditional technique ( standard group) for continue. The biliary intubationsuccess rate, intubation time, and post⁃ERCP complication rate were compared between the two groups. Results The rate of successful intubation of the double guidewire group was significantly higher than that ofthe standard group[96.7% (29 / 30) VS 74.1% (20 / 27), χ2 = 5.545, P = 0.019]. The intubation time ofthe double guidewire group was significantly shorter than that of the standard group (21.8±7.8 min VS 40.7±8.4 min, t = 8.076, P = 0.000). The double guidewire group had a similar incidence of post⁃ERCPcomplication compared to the standard group[13.3% (4 / 30) VS 11.1% (3 / 27), χ2 = 0.292, P = 0.596],and the complication in two groups was hyperamylasemia. Conclusion Double guidewire technique is safeand effective for difficult biliary cannulation because of perforation of duodenal papilla with a higher successrate and less time compared to classic technique.