肝胆胰外科杂志2025，Vol.37Issue(4)：236-242,7.DOI:10.11952/j.issn.1007-1954.2025.04.004
不同插管方法在ERCP困难胆管插管时的效果比较
Efficacy comparison of different cannulation methods for difficult biliary cannulation during endoscopic retrograde cholangiopancreatography
摘要
Abstract
Objective To compare the efficacy of different cannulation methods for difficult biliary cannulation during endoscopic retrograde cholangiopancreatography(ERCP).Methods A retrospective analysis was conducted on the case records of 2209 consecutive ERCP patients,who were admitted to Ruijin Hospital Affiliated to Shanghai Jiaotong University from Jun.1 2016 to Jan.31 2024.All patients were divided into 5 groups according to the chosen cannulation method for difficult biliary cannulation:Group 1,the double guide wire(DGW)group(n=35);Group 2,the transpancreatic precut sphincterotomy(TPS)group(n=40);Group 3,the pancreatic duct stent assisted transpancreatic precut sphincterotomy(PDS-TPS)group(n=105);Group 4,the precut over a pancreatic duct stent(PPDS)group(n=48)and Group 5,the needle knife fistulotomy(NKF)group(n=99).The biliary cannulation success rate,post-ERCP pancreatitis(PEP)incidence and the type of papilla morphology were compared and analyzed among the 5 groups.The patients with pancreatic duct stent placement were followed-up at the outpatient clinic 3 months after discharge.Results The proportion of type 3 papilla was highest in the NKF group(67.7%,67/99),while the proportion of type 1 papilla was highest in all the other 4 groups.The final successful biliary cannulation rates in each group,in the order of the highest to the lowest,were 97.1%for the PDS-TPS group,93.8%for the PPDS group,92.9%for the NKF group,90.0%for the TPS group,and 88.6%for the DGW group,there was no significant difference among the 5 groups(χ2=5.406,P=0.248).The incidence of PEP in each group,in the order of the lowest to the highest,was 0,1.0%,8.6%,17.1%27.5%for the PPDS group,NKF group,PDS-TPS group,DGW group,and TPS group,respectively,there was a significant difference among the 5 groups(χ2=25.482,P<0.001).When comparing the incidence of PEP incidence between two groups,the PPDS group and NKF group exhibited significantly lower incidence than that either in the TPS group or in the DGW group(P<0.05).Additionally,compared with the TPS group,the PDS-TPS group had a significantly lower PEP incidence rate(χ2=5.393,P=0.041),especially for the incidence rate of severe PEP,which was significantly higher in the TPS group than that in the PDS-TPS group(χ2=15.758,P=0.001).There was no significant difference between any other pairs of groups concerning PEP incidence rate.Among the 159 patients who received pancreatic duct stent placement,it was confirmed via abdominal X-ray examination 3 months after discharge,that 109 patients experienced spontaneous migration of the pancreatic duct stents.Of these,99 cases(88.4%,99/112)involved stents with the front wing removed,while 10 cases(21.3%,10/47)involved stents without the front wing removed,revealing a significant difference between the two groups(χ2=69.2,P<0.001).Conclusion For difficult biliary cannulation,if the guidewire enters into the pancreatic duct,pancreatic duct stent assisted biliary cannulation methods(PDS-TPS,PPDS)are better either than pancreatic wire assisted method(DGW)or than TPS.Moreover,pancreatic duct stent with the front wing removed usually falls offby itself.The NKF method is more suitable for type 3 large papilla.关键词
内镜逆行胆胰管造影/困难胆管插管/胰管支架表面括约肌预切开/经胰管括约肌预切开/针刀乳头造瘘/双导丝法Key words
endoscopic retrograde cholangiopancreatography(ERCP)/difficult biliary cannulation/precut over a pancreatic duct stent(PPDS)/transpancreatic precut sphincterotomy(TPS)/needle knife fistulotomy(NKF)/double guide wire(DGW)分类
临床医学引用本文复制引用
徐瑞云,李能平,李谦益,姚文飞,祁洋,吴宇权,姚伟,孔雷,陆一凡,陈胜..不同插管方法在ERCP困难胆管插管时的效果比较[J].肝胆胰外科杂志,2025,37(4):236-242,7.基金项目
上海市卫生和健康委员会科研课题(201740203). （201740203）
