目的探讨带连接线的鼻胆胰内外引流管在困难性胆管插管中的应用价值。方法回顾性分析同济大学附属东方医院胆石病中心2019年1月至12月实施困难性胆管插管术的患者临床资料,分为观察组(带连接线的鼻胆胰内外引流管)与对照组(鼻胆管+单猪...目的探讨带连接线的鼻胆胰内外引流管在困难性胆管插管中的应用价值。方法回顾性分析同济大学附属东方医院胆石病中心2019年1月至12月实施困难性胆管插管术的患者临床资料,分为观察组(带连接线的鼻胆胰内外引流管)与对照组(鼻胆管+单猪尾胰管支架),每组47例,比较两组术中胆管插管及引流管置入时间,术后急性胰腺炎及高淀粉酶血症发生率,胰管支架早期脱落及晚期未脱落率。结果观察组与对照组在胆管插管时间[(13.89±2.43)min vs(14.28±2.53)min,t=0.747,P=0.457]、术后急性胰腺炎[0 vs 4.3%(2/47),χ2=2.816,P=0.495]和高淀粉酶血症发生率[10.6%(5/47)vs 12.8%(6/47),χ2=0.103,P=0.748]方面差异无统计学意义。观察组引流管置入时间明显较对照组长[(4.30±0.83)min vs(2.15±0.66)min,t=13.885,P<0.001],胰管支架早期脱落率[0 vs 12.8%(6/47),χ2=8.727,P=0.026]及晚期未脱落率[0 vs 12.2%(5/41),χ2=7.984,P=0.019]均低于对照组。结论困难性胆管插管术中使用带连接线的鼻胆胰内外引流管其置入难度较大,但是具有移位率低、易取出的优点。展开更多
Background: Precut sphincterotomy has been widely performed to facilitate selective biliary access when standard cannulation attempts failed during endoscopic retrograde cholangiopancreatography(ERCP). However, scarce...Background: Precut sphincterotomy has been widely performed to facilitate selective biliary access when standard cannulation attempts failed during endoscopic retrograde cholangiopancreatography(ERCP). However, scarce data are available on different precut techniques for difficult biliary cannulation. This study aimed to evaluate the efficacy and safety of transpancreatic septotomy(TPS), needle-knife fistulotomy(NKF) or both based on the presence of unintentional pancreatic access and papillary morphology. Methods: Between March 2008 and December 2016, 157 consecutive patients undergoing precutting for an inaccessible bile duct during ERCP were identified. Precut techniques were chosen depending on repetitive inadvertent pancreatic cannulation and the papillary morphology. We retrospectively assessed the rates of cannulation success and procedure-related complications among three groups, namely TPS, NKF, and TPS followed by NKF. Results: The baseline characteristics of the three groups were comparable. The overall success rate of biliary cannulation reached 98.1%, including 111 of 113(98.2%) with TPS, 35 of 36(97.2%) with NKF and 8 of 8(100%) with NKF following TPS, without significant difference among groups. The incidences of total complications and post-ERCP pancreatitis were 9.6% and 7.6%, respectively. There was a trend towards less frequent post-ERCP pancreatitis after NKF(0%) compared with 11 cases(9.7%) after TPS and one case(12.5%) after NKF following TPS, but not significantly different( P = 0.07). No severe adverse event occurred during this study period. Conclusions: The choice of precut techniques by the presence of unintended pancreatic access and the papillary morphology brought about a high success rate without increasing risk in difficult biliary cannulation.展开更多
文摘目的探讨带连接线的鼻胆胰内外引流管在困难性胆管插管中的应用价值。方法回顾性分析同济大学附属东方医院胆石病中心2019年1月至12月实施困难性胆管插管术的患者临床资料,分为观察组(带连接线的鼻胆胰内外引流管)与对照组(鼻胆管+单猪尾胰管支架),每组47例,比较两组术中胆管插管及引流管置入时间,术后急性胰腺炎及高淀粉酶血症发生率,胰管支架早期脱落及晚期未脱落率。结果观察组与对照组在胆管插管时间[(13.89±2.43)min vs(14.28±2.53)min,t=0.747,P=0.457]、术后急性胰腺炎[0 vs 4.3%(2/47),χ2=2.816,P=0.495]和高淀粉酶血症发生率[10.6%(5/47)vs 12.8%(6/47),χ2=0.103,P=0.748]方面差异无统计学意义。观察组引流管置入时间明显较对照组长[(4.30±0.83)min vs(2.15±0.66)min,t=13.885,P<0.001],胰管支架早期脱落率[0 vs 12.8%(6/47),χ2=8.727,P=0.026]及晚期未脱落率[0 vs 12.2%(5/41),χ2=7.984,P=0.019]均低于对照组。结论困难性胆管插管术中使用带连接线的鼻胆胰内外引流管其置入难度较大,但是具有移位率低、易取出的优点。
文摘Background: Precut sphincterotomy has been widely performed to facilitate selective biliary access when standard cannulation attempts failed during endoscopic retrograde cholangiopancreatography(ERCP). However, scarce data are available on different precut techniques for difficult biliary cannulation. This study aimed to evaluate the efficacy and safety of transpancreatic septotomy(TPS), needle-knife fistulotomy(NKF) or both based on the presence of unintentional pancreatic access and papillary morphology. Methods: Between March 2008 and December 2016, 157 consecutive patients undergoing precutting for an inaccessible bile duct during ERCP were identified. Precut techniques were chosen depending on repetitive inadvertent pancreatic cannulation and the papillary morphology. We retrospectively assessed the rates of cannulation success and procedure-related complications among three groups, namely TPS, NKF, and TPS followed by NKF. Results: The baseline characteristics of the three groups were comparable. The overall success rate of biliary cannulation reached 98.1%, including 111 of 113(98.2%) with TPS, 35 of 36(97.2%) with NKF and 8 of 8(100%) with NKF following TPS, without significant difference among groups. The incidences of total complications and post-ERCP pancreatitis were 9.6% and 7.6%, respectively. There was a trend towards less frequent post-ERCP pancreatitis after NKF(0%) compared with 11 cases(9.7%) after TPS and one case(12.5%) after NKF following TPS, but not significantly different( P = 0.07). No severe adverse event occurred during this study period. Conclusions: The choice of precut techniques by the presence of unintended pancreatic access and the papillary morphology brought about a high success rate without increasing risk in difficult biliary cannulation.
文摘目的:应用网状荟萃分析,比较不同插管方法在内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)困难胆管插管时的效果。方法:选取英文发表的随机对照研究文献,对ERCP困难胆管插管时所采用的不同插管方法(早期或晚期针刀切开法、胰腺导丝辅助法、胰腺支架辅助法、经胰腺括约肌切开法、持续常规插管法)的效果,进行比较分析。主要观察指标为胆管插管成功率以及ERCP术后胰腺炎(post-ERCP pancreatitis,PEP)发生率。对不同插管方法的效果进行成对和网状荟萃分析,并根据累积排名曲线下面积(surface under the cumulative ranking curve,SUCRA)进行排名。结果:18项研究符合要求,共2033例病人。经胰腺括约肌切开法的胆管插管成功率显著高于持续常规插管法(RR=1.34,95%CI:1.02~1.77)、胰腺导丝辅助法(RR=1.26,95%CI:1.00~1.60)。根据SUCRA评分排名,经胰腺括约肌切开法胆道插管成功率最高,其次为早期针刀切开法。与持续常规插管法相比,只有早期针刀切开法可显著降低PEP发生率(RR=0.53,95%CI:0.30~0.94)。与胰腺导丝辅助法相比,早期针刀切开法(RR=0.41,95%CI:0.17~0.99)、经胰腺括约肌切开法(RR=0.49,95%CI:0.25~0.96)的PEP发生率均显著降低。根据SUCRA评分排名,早期针刀切开法对降低PEP发生率效果最显著,其次为经胰腺括约肌切开法。结论:经胰腺括约肌切开法可提高ERCP困难胆管插管时的胆管插管成功率;早期针刀切开法、经胰腺括约肌切开法可降低PEP发生率,可作为ERCP困难胆道插管时的选择方法。
