适时采用十二指肠乳头括约肌开窗术降低ERCP术后胰腺炎的临床价值

目的 评价适时采用十二指肠乳头括约肌开窗术对于ERCP术中插管困难患者术后胰腺炎发生的影响,探讨该手术的有效性和安全性.方法 回顾性分析2006年7月至2009年12月上海交通大学医学院附属新华医院收治的181例ERCP术中插管困难患者的临床资料,其中98例继续采用传统方式插管患者为对照组,83例适时行十二指肠乳头括约肌开窗术患者为研究组,比较两组患者选择性胆管插管的成功率及术后胰腺炎的发生率.计量资料的比较采用t检验,计数资料的比较采用x2检验,等级资料采用Wilcoxon秩和检验.结果 对照组和研究组患者首次插管成功率、术后高淀粉酶血症发生率、术后胰腺炎发生率分别为85.7％ (84/98)、7.1％(7/98)、10.2％( 10/98)和94.0％ (78/83)、18.1％ (15/83)、2.4％( 2/83),两组比较,差异有统计学意义(x2=10.12,5.03,4.41,P＜0.05).对照组和研究组患者中轻、中、重度胰腺炎分别为3、5、2例和1、1、0例,两组比较,差异有统计学意义(Z=-2.11,P＜0.05).结论 对于ERCP术中插管困难的患者适时采用十二指肠乳头括约肌开窗术可减少ERCP术后胰腺炎的发生,是一种安全、有效的方法.

Value of timely duodenal papilla fenestration for reducing the incidence of pancreatitis after endoscopic retrograde cholangiopancreatography

Objective To investigate the value of timely duodenal papilla fenestration for reducing the incidence of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP).Methods The clinical data of 181 patients with difficult biliary cannulatian during ERCP at the Xinhua Hospital of Shanghai Jiaotong University from July 2006 to December 2009 were retrospectively analyzed.Of the 181 patients,98 patients who received traditional incubation were in the control group,and the other 83 patients who received early duodenal papilla fenestration were in the test group.The success rate of selective incubation and incidence of pancreatitis were compared between the 2 groups.All data were analyzed using the t test,chi-square test or Wilcoxon rank sum test.Results The success rate of incubation,incidences of hyperamylasemia and pancreatitis were 85.7％ ( 84/98 ),7.1％ (7/98) and 10.2％ ( 10/98 ) in the control group,and 94.0％ ( 78/83 ),18.1％ ( 15/83 ) and 2.4％ (2/83) in the test group,respectively,and there were significant differences between the 2 groups (x2 =10.12,5.03,4.41,P＜0.05).The numbers of patients with mild,moderate and severe pancreatitis were 3,5 and 2 in the control group,and 1,1,0 in the test group,respectively,and there was a significant difference between the 2 groups ( Z =- 2.11,P ＜ 0.05 ).Conclusion Timely duodenal papilla fenestration is safe and effective in reducing the incidence of pancreatitis for patients with difficult biliary cannulation during ERCP.