早期经胰管方向Oddi括约肌预切开可减少ERCP术后胰腺炎发生

doi:10.16139/j.1007-9610.2020.04.008

摘要/Abstract

摘要：

目的：探讨内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography,ERCP）在困难插管操作中早期经胰管方向Oddi括约肌预切开方法对ERCP术后胰腺炎的影响。方法：对2018年6月至2019年11月期间,于我院胰胆外科行ERCP治疗的103例病人进行回顾性分析。比较插管中导丝第2次进入胰管后立即行沿胰管方向Oddi括约肌预切开（早期经胰管预切开组,42例）与多次尝试插管以至于导丝反复进入胰管（2次以上）后选择性插管成功或不成功再行胰管方向Oddi括约肌预切开（对照组,61例）间的术后相关并发症发生率及胰腺炎发生率。结果：早期经胰管预切开组与对照组最终均完成选择性胆道插管,但早期经胰管预切开组的插管时间明显短于对照组[（9.59±1.54） min比（13.33±2.09） min,P=0.022]。早期经胰管预切开组有3例ERCP术后胰腺炎,少于对照组（15例）,差异有统计学意义（P=0.033）。所有病例均为轻型胰腺炎,对症处理后好转。两组均无术后胆道感染,无术后出血。Logistic回归分析提示,插管时间>10 min,导丝进入胰管>2次是术后胰腺炎发生的独立危险因素。结论：对ERCP插管时导丝进入胰管的病人尽早（≤2次）行经胰管方向Oddi括约肌预切开是安全的,并有助于缩短插管时间,提高插管成功率,减少ERCP术后胰腺炎的发生率。

关键词: 内镜逆行胰胆管造影术, 经胰管方向Oddi括约肌切开, ERCP术后胰腺炎

Abstract:

Objective To investigate the effect of transpancreatic sphincterotomy(TPS) on post-ERCP pancreatitis (PEP) during endoscopic retrograde cholangiopancreatography (ERCP) for difficult biliary intubation. Methods A total of 103 cases undergoing ERCP in our hospital from June 2018 to November 2019 were analyzed retrospectively. Complications including PEP were compared between the cases in the group(42 cases) of early TPS in which the patients had sphincterotomy immediately after guidewire running into pancreatic duct for the second time and the cases in the control group (61 cases) in which the guidewire had entered pancreatic duct for more than 2 times before successful bile duct access by selective intubation or TPS. Results All the patients in both groups had biliary intubation successfully. However, the operative time in group of early TPS was much shorter than that in the control group [(9.59±1.54) min vs. (13.33±2.09) min, P=0.022]. There were 3 cases of PEP in the group of early TPS and 15 cases in the control group with statistical difference (P=0.033). All the cases of PEP were mild and recovered after conservative treatment. There were no biliary infections or postoperative bleedings in both groups. Logistic multivariate analysis showed that the time of intubation (≥10 min) and the times (>2 times) for the guidewire entering the pancreatic duct are the risk factors for PEP. Conclusions Early TPS when guidewire enters pancreatic duct ≤2 times would be safe. It could be helpful to shorten the time of intubation, increase the success rate of intubation and reduce the incidence of PEP.

Key words: Endoscopic retrograde cholangiopancreatography, Transpancreatic sphincterotomy, Post-ERCP pancreatitis

中图分类号:

R657.51

唐睿, 丁俊, 李甫, 黄金鑫, 张晞文. 早期经胰管方向Oddi括约肌预切开可减少ERCP术后胰腺炎发生[J]. 外科理论与实践, 2020, 25(04): 306-310.

TANG Rui, DING Jun, LI Fu, HUANG Jinxin, Zhang Xiwen. Early transpancreatic sphincterotomy reduces post-ERCP pancreatitis risk[J]. Journal of Surgery Concepts & Practice, 2020, 25(04): 306-310.

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参考文献 16

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分组	n	男/女	年龄（岁）	结石	良性狭窄/梗阻	恶性狭窄/梗阻
早期经胰管预切开组	42	23/19	57.4±14.2	13（31.0）	23（54.7）	6（14.3）
对照组	61^a)	35/26	60.2±17.3	22（36.0）	28（46.0）	11（18.0）

分组	胆管插管时间	X线照射时间
早期经胰管预切开组	9.6±1.5	4.3±0.9
对照组	13.3±2.1	8.8±2.8
P值	0.025	0.003

危险因素	B	S.E	Wald	Df	P值	Ex（B）	Ex（B）95%CI
插管时间>10 min	2.149	0.818	6.898	1	0.009	8.577	1.725~42.64
导丝进入胰管>2次	1.820	0.756	5.796	1	0.016	6.172	1.403~27.155
年龄	0.002	0.023	0.004	1	0.947	1.002	0.957~1.049
性别	-0.616	0.735	0.702	1	0.402	0.540	0.128~2.281
经胰管方向Oddi括约肌预切开^a)	-0.630	0.782	0.649	1	0.420	0.532	0.115~2.466