ERCP插管困难患者行二次ERCP的临床价值

目的评价ERCP插管困难患者择期行二次ERCP的安全性及其临床价值。方法212例ERCP插管困难患者，常规插管失败后先行乳头预切开，然后再尝试插管，超过1h仍未能成功插管者择期行二次ERCP诊疗，统计首次ERCP和总体ERCP（首次ERCP＋二次ERCP）插管成功率及并发症发生率，并行统计学分析。结果首次ERCP插管成功率为67．0％（142／212），总体ERCP插管成功率为90．6％（192／212），总体ERCP插管成功率明显高于首次ERCP（χ2=35．263，P〈0．05）。首次ERCP并发症发生率为8．96％（19／212），总体ERCP并发症发生率为10．38％（22／212），其中二次ERCP并发症发生率为4．29％（3／70），总体ERCP以及二次ERCP并发症发生率与首次ERCP比较差异均无统计学意义（P〉0．05）。结论ERCP插管困难行乳头预切开后仍不能完成插管者，择期行二次ERCP安全有效。

Clinical value of secondary ERCP with difficult intubation

Objective To determine the safety and clinical value of secondary ERCP to a failed in- tubation procedure. Methods A total of 212 patients with difficult intubation during ERCP procedures were enrolled. Patients with failed conventional intubation accepted precut sphincterotomy. The operation stopped after one hour of effort. A secondary selective ERCP was performed at a appropriate time. The operation suc- cess rate and complication rate of first ERCP and secondary ERCP were compared. Results The success rate of first ERCP was 67.0% （ 142/212）, and the total success rate was 90. 6% （192/212）. The total success rate is significantly higher than that of first ERCPoperation（χ2 = 35. 263 ,P 〈 0. 05 ）. The complication rate of first ERCP, secondary ERCP and total complication rate was 8.96% （ 19/212 ）, 4. 29% （ 3/70 ）, 10. 38% （22/212） , respectively. Complication rates of total ERCP and secondary ERCP were not signifi- cantly different from the first ERCP （ P 〉 0. 05 ）. Conclusion It is safe and effective for patients with failed ERCP intubations after precut to receive a secondary ERCP at a appropriate time.