摘要
目的探讨经内镜逆行性胰胆管造影(ERCP)选择性插管困难的影响因素,为评估患者手术风险、较早设计出合理的应对策略提供参考依据。方法选取2012—2016年上海市浦东医院普外科首次行ERCP患者1 120例,按照是否出现选择性插管困难将其分为插管顺利组(918例)和插管困难组(202例)。记录两组性别、年龄、合并症、术前结石嵌顿及壶腹部肿瘤发生情况、急诊ERCP、ERCP指征、憩室分布情况、胆胰管汇合方式、乳头形态、瘘管、疑似胆管狭窄及Oddi括约肌功能紊乱(SOD)发生情况。结果多因素Logistic回归分析结果显示,术前结石嵌顿[OR=11.420,95%CI(5.569,23.414)]、术前壶腹部肿瘤[OR=3.370,95%CI(2.023,5.609)]、乳头中心不对称憩室[OR=4.970,95%CI(2.862,8.623)]、憩室内乳头[OR=26.210,95%CI(8.126,84.533)]、隔壁型(V型)胆胰管[OR=6.990,95%CI(1.121,43.557)]、共同通道型(Y型)胆胰管[OR=16.670,95%CI(2.621,106.073)]、乳头轴向偏斜[OR=20.180,95%CI(11.748,34.655)]、乳头膨大[OR=16.710,95%CI(8.753,31.896)]、乳头狭窄[OR=13.640,95%CI(5.199,35.764)]、疑似胆管狭窄[OR=2.100,95%CI(1.067,4.129)]、SOD[OR=2.900,95%CI(1.516,5.564)]是ERCP选择性插管困难的影响因素(P<0.05)。202例选择性插管困难患者中,行乳头切开者131例(64.8%),行长镜身技术者100例(49.5%),行双导丝者92例(45.5%),行更换导丝者90例(44.6%);单独使用1种辅助策略技术者50例(24.8%),2种技术联合使用者95例(47.0%),3种技术联合使用者57例(28.2%);行辅助策略后成功者151例(74.8%)。插管顺利组患者与选择性插管困难成功亚组患者高淀粉酶血症、消化道出血及穿孔、胰腺炎、胆管炎发生率比较,差异均无统计学意义(P>0.05)。结论相关解剖因素和疾病特征对ERCP选择性插管困难具有预测作用,可根据患者具体指标选择针对性的辅助策略,从而减少选择性插管次数和操作时间,提高胆胰系统疾病的诊疗水平。
Objective To explore the influencing factors for the difficulties in elective endotracheal intubation during endoscopic retrograde cholangiopancreatography（ERCP）,providing a reference for assessing the patient＇s surgical risk,and formulating targeted strategy for such difficulties.Methods We recruited 1 120 patients who initially underwent ERCP in Department of General Surgery,Shanghai Pudong Hospital from 2012 to 2016.Of them,202 with difficulties in endotracheal intubation during ERCP and 918 without were assigned to difficult intubation group,and successful intubation group,respectively.We reviewed their data such as gender,age,preoperative incidence rates of comorbidity,stone incarceration,ampullary neoplasms,emergency ERCP,and indications of ERCP,as well as the anatomical variants[duodenal diverticulum,pancreaticobiliary maljunction,papilla abnormalities,fistula,suspected biliary stricture and sphincter of Oddi dysfunction（SOD）].Results Multivariate Logistic regression analysis showed that the preoperative stone incarceration[OR=11.420,95%CI（5.569,23.414）],preoperative ampullary neoplasms[OR=3.370,95%CI（2.023,5.609）],central asymmetrical diverticulum of the papilla[OR=4.970,95%CI（2.862,8.623）],intradiverticular papilla[OR=26.210,95%CI（8.126,84.533）],confluence of pancreaticobiliary duct wall[OR=6.990,95%CI（1.121,43.557）],common channel of pancreaticobiliary ducts[OR=16.670,95%CI（2.621,106.073）],axial deflection of papilla[OR=20.180,95%CI（11.748,34.655）],papillae enlargement[OR=16.710,95%CI（8.753,31.896）],papillary stenosis[OR=13.640,95%CI（5.199,35.764）],suspected biliary stricture[OR=2.100,95%CI（1.067,4.129）] and SOD[OR=2.900,95%CI（1.516,5.564）] were influencing factors for difficulties in elective endotracheal intubation during ERCP（P〈0.05）.Of the 202 patients with difficulties in endotracheal intubation,131（64.8%） underwent papillotomy,100（49.5%） used deep enterscopy technique,92（45.5%） used double wire-guided technique,and 90（44.6%�
作者
张昊
高黎黎
薛冰
蔡雷
ZHANG Hao;GAO Li-li;XUE Bing;CAI Lei(Department of General Surgery,Shanghai Pudong Hospital/Fudan University Pudong Medical Center,Shanghai 201399,China;Medical Scientific Research and Innovation Center,Shanghai Pudong Hospital/Fudan University Pudong Medical Center,Shanghai 201399,China)
出处
《中国全科医学》
CAS
北大核心
2018年第14期1689-1693,共5页
Chinese General Practice
基金
上海市浦东新区卫生和计划生育委员会科技发展专项基金资助青年科技项目(PW2016B-15)
上海市浦东医院人才引进基金项目(2015YJ-09)
关键词
胰胆管造影术
内窥镜逆行
选择性插管困难
胰腺管
影响因素分析
Cholangiopancreatography,endoscopic retrograde
Difficulty in selective intubation
Pancreatic ducts
Root cause analysis
