小IT刀预切开辅助插管与常规切开刀导丝插管对选择性胆管插管的效果比较（含视频）

Comparative effectiveness research on small IT knife pre-cut and conventional guidewire cannulation on selective biliary intubation (with video)

摘要:

目的 评估小IT刀预切开辅助十二指肠乳头插管的应用价值。方法 回顾性分析2016年5月—2019年7月在南京鼓楼医院消化内镜中心行经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography，ERCP)的90例胆总管结石患者资料，其中52例行小IT刀预切开辅助插管（小IT刀组），另外38例行常规切开刀导丝插管（常规组）。收集并比较两组患者的基本资料、疗效及并发症情况。结果 小IT刀组与常规组性别构成差异有统计学意义（χ2=5.679，P=0.017），其他基线资料比较差异无统计学意义（P>0.05）。小IT刀组中位插管时间141.5 s，常规组270.0 s，两组比较差异有统计学意义（Z=1 268.0，P=0.022）。两组插管成功率比较差异无统计学意义[98.1%（51/52）比94.7%（36/38）， χ2=0.760，P=0.571]。两组术中出血发生率[15.4%（8/52）比7.9%（3/38）， χ2=1.148，P=0.345]、术后胰腺炎发生率[5.8%（3/52）比7.9%（3/38）， χ2=0.159，P=0.694]和胆管炎发生率[1.9%（1/52）比5.3%（2/38）， χ2=0.760，P=0.571]比较差异无统计学意义。两组均未发生术后穿孔。根据操作者熟练程度分层后比较，小IT刀专家组与常规插管专家组间的中位插管时间比较差异有统计学意义（116.0 s比258.0 s，Z=276.0，P=0.038），其余各组间插管时间差异均无统计学意义（P>0.05）。结论 小IT刀预切开辅助插管安全、有效，并可能缩短ERCP插管时间。

Abstract:

Objective To evaluate the application value of small IT knife pre-cut in assistance to duodenal papillary cannulation compared with conventional guidewire cannulation. Methods A retrospective analysis was performed on the data of 90 patients with choledocholithiasis including 52 patients with small IT knife pre-cut assisted intubation (small IT knife group) and 38 patients with conventional guidewire intubation (conventional group) in endoscopic retrograde cholangiopancreatography (ERCP) from May 2016 to July 2019 in the digestive endoscopy center of Nanjing Drum Tower Hospital. The basic data, curative effect and complications of the two groups were collected and compared. Results There was statistically significant difference in gender composition between the small IT knife group and the conventional group (χ2=5.679, P=0.017), but no significant difference in other baseline data between the two groups (all P>0.05). The median intubation time of the small IT knife group was significantly shorter than that of the conventional group (141.5 s VS 270.0 s, Z=1 268.0, P=0.022). There were no significant differences in the success rate of intubation [98.1% (51/52) VS 94.7% (36/38), χ2=0.760, P=0.571], the incidence of intraoperative bleeding [15.4% (8/52) VS 7.9% (3/38), χ2=1.148, P=0.345], postoperative pancreatitis [5.8% (3/52) VS 7.9% (3/38),χ2=0.159, P=0.694], and postoperative cholangitis [1.9% (1/52) VS 5.3% (2/38), χ2=0.760, P=0.571] between the two groups. No perforation occurred in the two groups. After stratifying according to the operator's proficiency, the median intubation time was significantly different between the small IT knife expert group and the conventional expert group (116.0 s VS 258.0 s, Z=276.0, P=0.038), while there was no significant difference in the intubation time among other groups (all P>0.05). Conclusion The small IT knife is safe and effective to pre-cut and assist intubation in ERCP, and it may shorten the intubation time.