胰管塑料支架和/或鼻胆管引流在内镜逆行胰胆管造影术选择性胆管插管困难时的应用研究*

摘要： 目的??探讨胰管塑料支架和/或鼻胆管引流在胆总管结石患者内镜逆行胰胆管造影术（ERCP）选择性胆管插管困难（DSBC）时的应用。方法?回顾性分析57例ERCP术中DSBC的胆总管结石患者的临床资料，将患者分为胰管塑料支架组、鼻胆管引流组、胰管塑料支架+鼻胆管引流组，观察其手术成功率、术后并发胰腺炎、高淀粉酶血症或其他并发症的发生率，对比分析3组间的差异。结果?接受ERCP的57例患者中，胰管塑料支架组13例患者，手术成功2例（15.4%），高淀粉酶血症1例（7.7%），术后胰腺炎2例（15.4%），发热1例（7.7%），出血1例（7.7%）；鼻胆管引流组20例患者，手术成功20例（100.0%），无高淀粉酶血症及术后胰腺炎，无出血及发热等并发症的发生；胰管塑料支架+鼻胆管引流组24例患者1次ERCP手术成功19例（79.2%），2次ERCP成功5例（20.8%），4例出现高淀粉酶血症（16.7%），2例出现出血（8.3%），无发热及术后胰腺炎。3组间比较术后胰腺炎的发生和手术成功率差异有统计学意义。结论?ERCP术中DSBC的患者可通过放置胰管支架和/或鼻胆管引流术提高手术的成功率，减少胰腺炎的发生。
Abstract: Objective?To explore the application of plastic pancreatic stents and/or nasal biliary drainage for choledocholithiasis patients having DSBC during Endoscopic Retrograde Cholangiopancreatography (ERCP).?Methods?Retrospective analysis on clinical data of 57 ERCP cases aiming at choledocholithiasis patients having DSBC from January 2010 to December 2015 has been carried out. According to the guide wire cannulation in an operation, patients are divided into three groups, i.e. plastic pancreatic stents group, nasal biliary drainage group, and plastic pancreatic stents + nasal biliary drainage group, so as to observe the success rate of operation and the occurrence rate of postoperative complications, such as pancreatitis or hyperamylasemia, as well as to compare the differences between the three groups.?Results?Out of the 57 patients receiving ERCP, 13 patients are in the plastic pancreatic stents group, with two successful operations (15.4%), one case of hyperamylasemia (7.7%), two cases of postoperative pancreatitis (15.4%), one case of fever (7.7%) and one case of hemorrhage (7.7%); 20 patients are in the nasal biliary drainage group, with 20 successful operations (100.0%), no occurrence of hyperamylasemia or postoperative pancreatitis or other complications including hemorrhage and fever; 24 patients are in the plastic pancreatic stents + nasal biliary drainage group, with 19 ERCP operations succeeded at the first attempt (79.2%) and 5 ERCP operations succeeded at the second try (20.8%), as well as 4 cases of hyperamylasemia (16.7%), 2 cases of hemorrhage (8.3%) , no occurrence of fever cases and postoperative pancreatitis. In comparison between the three groups, the occurrence of postoperative pancreatitis and successful rate of operation show a significant difference.?Conclusion?By adopting plastic pancreatic stents and/or nasal biliary drainage for patients having a difficult selective biliary cannulation during ERCP, the success rate of operation can be improved, and the occurrence of pancreatitis can also be reduced.