导丝引导下选择性胆管插管预防ERCP术后胰腺炎和高淀粉酶血症的作用

目的 探讨双"十"字交叉标准代替造影剂下的Metro斑马导丝引导下选择性胆管插管技术对ERCP(endoscopic retrograde choledochopancreatography)术后胰腺炎和高淀粉酶血症的预防作用.方法 需要接受ERCP的291例胆系疾病病人随机分为导丝组(149例)和对照组(142例),导丝组ERCP-1造影导管内置Metro导丝直接选择性胆管插管,借助导丝判断胆管,然后再注入造影剂以及其他治疗性操作;对照组则单纯ERCP-1造影选择性胆管插管,注入造影剂判断胆管,再进行其他治疗性操作.比较两组ERCP后胰腺炎和高淀粉酶血症的发生情况.结果 选择性胆管插管成功283例,其中导丝组145例,对照组138例.导丝组术后胰腺炎发生率和高淀粉酶血症发生率均明显低于对照组,且导丝组的胰腺炎严重程度有减轻的趋势.结论 借助双"十"字交叉标准代替造影剂下的Metro导丝引导下选择性胆管插管不仅可以降低ERCP术后胰腺炎和高淀粉酶血症的发生率,而且可以降低ERCP术后胰腺炎的严重程度.

Preventive effects of guidewire-guided selective bile ductal cannulation on pancreatitis and hyperamylasemia after ERCP

Objective To study the preventive effects of selective bile ductal cannulation using an aqua-coat tipped Metro tracer guidewire on pancreatitis and hyperamylasemia after ERCP. Methods A total of 291 patients with biliary disease were enrolled in the study. The patients were randomized into the guidewire group (n= 149) and the control group (n= 142). In the guidewire group, the bile duct was first accessed by insertion of an aqua-coat tipped Metro tracer (diameter 0. 029 inch) guidewire through a 5.5Fdouble channel ERCP-tube to judge the bile duct by the direction of guidewire. As soon as cannulation was accomplished, the guidewire was removed to allow injection of contrast medium and other therapeutic manipulation. In the control group, the bile duct was opacified by the traditional method of cannulation of the biliary tree followed by single ERCP-tube cannulation, judgment of the bile duct by injection of contrast medium and performance of other therapeutic procedures. The incidences of post-ERCP pancreatitis and hyperamylasemia were compared between the 2 groups. Results The selective bile ductal cannulation was successfully conducted in 145 patients in the guidewire group and 138 in the control group. The incidences of post-ERCP pancreatitis and hyperamylasemia were significantly lower in the guidewire group than in the control group. Pancreatitis tended to be less severe for patients in the guidewire group. Conclusion Using the Double-Crossing method in selective bile ductal cannulation with an aqua-coat tipped Metro tracer guidewire reduced not only the frequencies of post-ERCP pancreatitis and hyperamylasemia but also the severity of post-ERCP pancreatitis.