金属夹与黏膜下注射辅助插管技术在内镜逆行胰胆管造影术困难插管中的应用（含视频）

Application of endoclip‑ and submucosal injection‑assisted cannulation technique to difficult cannulation during endoscopic retrograde cholangiopancreatography (with video)

摘要:

目的 探讨金属夹辅助与黏膜下注射辅助插管技术在内镜逆行性胰胆管造影术（endoscopic retrograde cholangiopancreatography，ERCP）困难插管中的临床价值。方法 回顾性分析2015年6月—2020年9月在海军军医大学第一附属医院初次行ERCP的12 458例患者资料，其中采用金属夹或黏膜下注射辅助插管的困难插管患者28例（0.22%），分析两种技术在困难插管患者的插管成功率、插管时间及并发症发生率。结果 28例采用金属夹或黏膜下注射辅助插管患者，男18例（64.3%）、女10例（35.7%），年龄（69.6±14.1）岁。乳头分型：Ⅱ型5例（17.9%），Ⅲ型5例（17.9%），Ⅴ型18例（64.3%）。采用金属夹辅助插管16例（57.1%），黏膜下注射辅助插管12例（42.9%），其中25例（89.3%）顺利完成选择性插管，插管时间（9.9±4.3）min。出现轻度ERCP术后胰腺炎1例（3.6%），术后高淀粉酶血症3例（10.7%），未出现术后出血或穿孔者，所有患者经保守治疗治愈出院。结论 对于乳头暴露不佳、位置偏斜等原因而选择性插管困难时，继续用金属夹或黏膜下注射辅助插管，可有效提高ERCP选择性插管成功率，且并发症发生率较低，值得临床推广。

Abstract:

Objective To evaluate the value of endoclip-assisted and submucosal injection-assisted cannulation techniques for difficult cannulation during endoscopic retrograde cholangiopancreatography (ERCP). Methods Data of 12 458 patients treated with ERCP for the first time in the First Affilated Hospital of Naval Medical University from June 2015 to September 2020 were retrospectively analyzed. Twenty eight (0.22%) were identified as difficult cannulation where metal clip- or submucosal injection-assisted cannulation was used. The selective cannulation success rate, intubation time and complication incidence of the two techniques in difficult cannulation patients were analyzed. Results Difficult cannulation was performed in 18 males (64.3%) and 10 females (35.7%) with an age of 69.6±14.1 years assisted by metal clips or submucosal injection. Five cases (17.9%) were type Ⅱ, 5 cases (17.9%) type Ⅲ, and 18 cases (64.3%) type Ⅴ according to papilla classification. Sixteen patients (57.1%) received metal clip-assisted cannulation, and 12 cases (42.9%) submucosal injection-assisted cannulation. Twenty-five (89.3%) patients successfully underwent selective cannulation with the cannulation time of 9.9±4.3 min. One case (3.6%) of mild post-ERCP pancreatitis and 3 cases (10.7%) of post-ERCP hyperamylasemia occurred. No postoperative bleeding or perforation occurred. All patients were cured and discharged after conservative treatment. Conclusion When selective cannulation is difficult due to poor papilla exposure or deflection, endoclip- or submucosal injection-assisted cannulation can effectively improve the successful selective cannulation rate during ERCP with low complication incidence, which is worth of clinical promotion.