逆行胰胆管造影早期预切开时间对困难插管患者术后胰腺炎发生率的影响

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摘要目的探讨早期预切开时间对困难插管患者内镜下逆行胰胆管造影(endoscopic retrograde cholangiopancreatography, ERCP)术后胰腺炎发生率的影响。方法回顾性分析武警安徽总队医院从2014-03至2019-11行ERCP因困难插管而预切开符合条件患者临床资料,共187例,根据预切开时间分成两组,早期预切开(A组)85例,延迟预切开(B组)102例,对两组患者的基本情况、与患者自身及手术操作相关的ERCP术后胰腺炎(post-ERCP pancreatitis, PEP)高风险因素、预切开后插管成功率及术后发生胰腺炎情况进行比较。两组均未给予吲哚美辛栓纳肛,术后均未放置胰管支架。结果 A组ERCP术后胰腺炎(post-ERCP pancreatitis, PEP)发生率为4.71%(4/85),B组PEP发生率为14.71%(15/102),A组发生率低于B组, 差异有统计学意义(P<0.05)。A组4例PEP均为轻度胰腺炎;B组15例PEP中1例为重度胰腺炎,其余为轻度胰腺炎。两组预切开后选择性胆管插管成功率,A组为92.94%(79/85),B组为85.29%(87/102)。两组术后出血、穿孔、胆管炎等并发症发生率无统计学差异,两组均无死亡病例。结论对ERCP手术困难插管患者,早期预切开可降低PEP发生率,提高插管成功率,安全有效。

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	杨红旗
	郭艳芳
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	洪丽莉
	施俊超
	曹济凡
	周婷婷

关键词 ：早期预切开, 困难插管, ERCP术后胰腺炎

Abstract：Objective To investigate the effect of early precut sphincterotomy on the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP) in patients with difficult biliary access.Methods According to the precut time, 187 patients who were referred to Anhui Provincial Corps Hospital of Chinese People's Armed Police Force for ERCP due to difficult biliary cannulation between March 2014 and November 2019 were divided into the early precut group (group A,n=85) and the delayed precut group (Group B,n=102). The success rate of cannulation and the incidence of PEP were compared between the two groups. No rectal indomethacin or pancreatic stent was used for prevention of PEP.Results The incidence of PEP was 4.71%(4/85)in group A and 14.71%(15/102)in group B, so the difference was statistically significant (P<0.05). One of the 15 cases of PEP was severe in group B. There was no significant difference in the incidence of postoperative bleeding, perforation, cholangitis or other complications between the two groups. There was no mortality in either group.Conclusions In patients with difficult biliary cannulation, early precut sphincterotomy is an effective approach and can significantly reduce the incidence of PEP.

Key words： early precut sphincterotomy difficult biliary access post-endoscopic retrograde cholangiopancreatography pancreatitis

收稿日期: 2020-05-20

ZTFLH:

R657.5

作者简介: 杨红旗,本科学历,副主任医师。

引用本文:

杨红旗, 郭艳芳, 彭辉, 洪丽莉, 施俊超, 曹济凡, 周婷婷. 逆行胰胆管造影早期预切开时间对困难插管患者术后胰腺炎发生率的影响[J]. 武警医学, 2021, 32(2): 105-107. YANG Hongqi, GUO Yanfang, PENG Hui, HONG Lili, SHI Junchao, CAO Jifan, ZHOU Tingting. Effect of early precut sphincterotomy on incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP) in patients with difficult biliary access. Med. J. Chin. Peop. Armed Poli. Forc., 2021, 32(2): 105-107.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2021/V32/I2/105

[1]	Wu D, Lu B, Xue H D, et al. Validation of modified determinant-based classification of severity for acute pancreatitis in a tertiary teaching hospital[J].Pancreatology,2019,19(2):217-223.
[2]	Tenner S, Baillie J,Witt J, et al. American College of Gastroenterology Guideline: management of acute pancreatitis [J].AMJ Gastroenterol,2013,108:14100-14115.
[3]	Mine T, Morizane T, Kawaguchi Y, et al. Clinical practice guideline for post-ERCP pancreatitis[J]. J Gastroenterol, 2017, 52(9):1013-1022.
[4]	Dumonceau J M, Andriulli A, Elmunzer B J, et al. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy(ESGE) Guideline-updated June 2014[J].Endoscopy,2014,46:799-815.
[5]	Swan M P, Alexander S, Moss A, et al. Needle knife sphincterotomy does not increase the risk of pancreatitis in patients with diffcult biliary cannulation[J]. Clin Gastroenterol Hepatol,2013,11: 430-436.
[6]	Testoni P A, Giussani A, Vailati C, et al. Precut sphincterotomy, repeated cannulation and post-ERCP pancreatitis in patients with bile duct stone disease[J]. Dig Liver Dis, 2011, 43:792-796.
[7]	Cennamo V, Fuccio L, Zagari R M, et al. Can early precut implementa-tion reduce endoscopic retrograde cholangiopancreatography related complication risk? Meta-analysis of randomized controlled trials [J]. Endoscopy, 2010, 42(5):381-388.
[8]	Hiroshi K,Yoshimasa K,Shuhei K, et al. Transpapillary selective bile duct cannulation technique:review of Japanese randomized controlled trials since 2010 and an overview of clinical results in precut sphincterotomy since 2004[J]. Dig Endosc,2016, 28: 77-95.
[9]	Manes G, DiGiorgio P, Repici A, et al. An analysis of the factors associated with the development of complications in patients undergoing precut sphincterotomy: a prospective, control, randomized, multicenterstudy[J]. AMJ Gastroenterol, 2009, 104: 2412-2417.
[10]	Yildirim A E, Kadayifci A. Repeated cannulation attempts or late precut : which is more risky for post-ERCP pancreatitis? [J].Endoscopy, 2016, 48: 955.
[11]	Sundaralingam P, Masson P, Bourke M J. Early precut Sphincterotomy does not increase risk during endoscopic retrogradecholangiopancreatography in patients with difficult biliary access: a meta-analysis of randomized controlled trials[J]. Clin Gastroenterol Hepatol, 2015, 13:1722-1729.
[12]	Lopes L, Dinis-Ribeiro M, Rolanda C. Early precut fistulotomy for biliary access: time to change the paradigm of “the later, the better”? [J].GIE, 2014, 80: 634-641.