预切开窗后插管失败再次胆管插管的体会 |
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引用本文: | 张啸,郭英辉,林秀英.预切开窗后插管失败再次胆管插管的体会[J].中华消化内镜杂志,2014(4):210-212. |
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作者姓名: | 张啸 郭英辉 林秀英 |
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作者单位: | 作者单位:310006杭州市第一人民医院消化科 |
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摘 要: | 目的探讨对经内镜逆行胰胆管造影术(ERCP)预切开或开窗方法后胆管插管失败者,行第2次ERCP操作的价值。方法167例患者术前拟诊胆总管结石和/或良性乳头狭窄109例,胆胰占位性病变58例。第一次ERCP标准胆管插管均在20min以上,不能成功后作预切开或开窗术,再反复试插后仍未能成功;3~5d后,再次行ERCP;第2次ERCP大多数患者按胆胰管合流水平位、前位和后位顺序插管。结果133例(79.6%)经第2次ERCP获得成功,其中水平位插管成功85例,前位插管成功36例,后位插管成功12例。插管成功后顺利完成了内镜的相应治疗。1例发生乳头穿孔伴后腹膜感染,1例并发重症胰腺炎形成胰周脓肿,均经腹腔穿刺引流方法治愈。结论经过更缜密的准备,掌控好胆管插管技巧,再次ERCP仍有较高的成功率。
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关 键 词: | 胰胆管造影术 内窥镜逆行 重做 胆胰管合流异常 |
A second ERCP for the failure of pre-cut ERCP |
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Institution: | Zhang Xiao, Guo Yinghui, Hn Xiuying. Department of Gastroenterology, The First People's Hospital of Hangzhou, Hangzhou 310006, China Corresponding author: [.in Xiuying , Entail: linxiuyS18@ sina. corn |
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Abstract: | Objective To study the therapeutic value of a second ERCP for the patients with failure of pre-cut ERCP. Methods A total of 167 cases of pre-cut ERCP failure were recruited to the study, among which 109 cases were diagnosed as common bile duct stones and/or benign papillary stenosis, and 58 cases as biliopancreatic lesion. ERCP failed with standard intubation for more than 20 minutes, even with pre-cut or fenestration. A second ERCP was preformed after rest of 3-5 days. The position sequence of intubation for most patients was horizontal, the front and rear. Results The success rate was 79. 6% ( 133 cases) for the patients with a second ERCP, 85 patients received the procedures via the horizontal intubation, 36 via anteri- or, and 12 via posterior intubation. The treatments were performed after successful completion of the endo- scopic cannulation. One patient had retroperitoneal infection with duodenal perforation, another patient had severe pancreatitis, who were cured by the intervention methods. Conclusion The success rate of a second ERCP is high with proficient intubation skills. |
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Keywords: | Cholangiopancreatography endoscopic retrograde Redo Bile duct confluence abnormality |
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