ERCP患者行十二指肠乳头预切开术的影响因素分析
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摘要
目的探讨内镜下逆行胰胆管造影(ERCP)患者行十二指肠乳头预切开术(Precut术)的影响因素。方法回顾性分析2016年11月～2018年1月甘肃省第二人民医院及庆阳市人民医院行ERCP患者983例,所有患者均行常规插管,对常规插管困难患者行Precut术,比较常规插管和全部插管成功率与并发症发生率、分析乳头解剖因素及疾病因素与预切开率情况,多元Logistic回归分析预切开影响因素。结果全部插管成功率为97.76%,高于常规插管的84.94%,差异有统计学意义(P<0.05)。解剖因素中乳头肥厚狭长患者预切开率最高,憩室旁乳头预切开率最低;疾病因素中外伤后黄疸预切开率最高,肝门部转移癌、肝门部占位、Oddi括约肌功能失调及Oddi括约肌功能失调预切开率最低。多元Logistic回归分析预切开术影响因素结果显示:单纯胆管结石、憩室旁乳头是预切开保护因素,硬化性乳头炎、Oddi括约肌狭窄、十二指肠乳头肥厚狭长是预切开危险因素。Precut术与常规插管并发症总发生率比较,差异无统计学意义(P>0.05)。结论 ERCP插管困难时可以采取Precut术辅助插管,有助于提高插管成功率,降低并发症发生率。患者本身某些解剖及病理因素是插管困难行预切开术的影响因素,硬化性乳头炎、Oddi括约肌狭窄、十二指肠乳头肥厚狭长常规插管失败率较高,需行Precut术完成。
Objective To investigate the influencing factors of duodenal papillary pre-cutting(Precut) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP). Methods A retrospective analysis of 983 patients with ERCP from Gansu Second People's Hospital and Qingyang People's Hospital from November 2016 to January 2018. All patients underwent routine intubation. Precut was performed on patients with conventional intubation difficulties. The success rate of conventional intubation and all intubation and complication rate, analysis of nipple anatomical factors and disease factors and pre-cut rate, multivariate logistic regression analysis of pre-cut factors. Results The success rate of all intubation was97.76%, which was higher than that of conventional intubation 84.94%,the difference was statistically significant( P <0.05). Among the anatomical factors, the pre-cut rate of the nipple hypertrophy is the highest, and the pre-cut rate of the paraventricular nipple is the lowest. The disease factor has the highest pre-cut rate of jaundice after trauma, the metastasis of the hilar, the hilar mass, and the Oddi sphincter dysfunction. And Oddi sphincter dysfunction pre-cut rate is the lowest. Multivariate logistic regression analysis showed that the influencing factors of pre-surgery showed that simple bile duct stones and diverticulum nipples were pre-cut protective factors. Sclerosing papillitis,Oddi sphincter stenosis, and duodenal papilla hypertrophy were pre-cut risk factors. There was no significant difference in the total incidence of complications between Precut and conventional intubation(P>0.05). Conclusion Preoperative assisted intubation can be performed when ERCP is difficult, which can improve the success rate of intubation and reduce the incidence of complications. Some anatomical and pathological factors of the patient itself are the influencing factors of intubation difficulty pre-surgery, sclerosing papillitis,Oddi sphincter stenosis, duodenal papilla hypertrophy, long narrow conventional intubation failure rate, need to be completed by Precut.
Objective To investigate the influencing factors of duodenal papillary pre-cutting(Precut) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP). Methods A retrospective analysis of 983 patients with ERCP from Gansu Second People's Hospital and Qingyang People's Hospital from November 2016 to January 2018. All patients underwent routine intubation. Precut was performed on patients with conventional intubation difficulties. The success rate of conventional intubation and all intubation and complication rate, analysis of nipple anatomical factors and disease factors and pre-cut rate, multivariate logistic regression analysis of pre-cut factors. Results The success rate of all intubation was97.76%, which was higher than that of conventional intubation 84.94%,the difference was statistically significant( P <0.05). Among the anatomical factors, the pre-cut rate of the nipple hypertrophy is the highest, and the pre-cut rate of the paraventricular nipple is the lowest. The disease factor has the highest pre-cut rate of jaundice after trauma, the metastasis of the hilar, the hilar mass, and the Oddi sphincter dysfunction. And Oddi sphincter dysfunction pre-cut rate is the lowest. Multivariate logistic regression analysis showed that the influencing factors of pre-surgery showed that simple bile duct stones and diverticulum nipples were pre-cut protective factors. Sclerosing papillitis,Oddi sphincter stenosis, and duodenal papilla hypertrophy were pre-cut risk factors. There was no significant difference in the total incidence of complications between Precut and conventional intubation(P>0.05). Conclusion Preoperative assisted intubation can be performed when ERCP is difficult, which can improve the success rate of intubation and reduce the incidence of complications. Some anatomical and pathological factors of the patient itself are the influencing factors of intubation difficulty pre-surgery, sclerosing papillitis,Oddi sphincter stenosis, duodenal papilla hypertrophy, long narrow conventional intubation failure rate, need to be completed by Precut.
引文
[1]李攀,卢媛,张彦,等.Precut技术在ERCP插管困难患者中的有效应用[J].临床和实验医学杂志,2017,16(21):2144-2147.
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[6]Navaneethan U,Konjeti R,Venkatesh PG,et al.Early precut sphincterotomy and the risk of endoscopic retrograde cholangiopancreatography related complications:An updated Metaanalysis[J].World J Gastrointest Endosc,2014,6(5):200-208.
[7]Tang Z,Yang Y,Yang Z,et al.Early precut sphincterrrrotomy does not increase the risk of adverse events for patients with difficult biliary access[J].Medicine,2018,97(36):e12213.
[8]Choudhary A,Winn J,Siddique S,et al.Effect of precut sphincterotomy on post-endoscopic retrograde cholangiopancreatography pancreatitis:A systematic review and Meta-analysis[J].World J Gastroenterol,2014,20(14):4093-4101.
[2]李伟志,秦鸣放,王庆,等.早期预切开术在经内镜逆行胰胆管造影困难胆管插管中的应用[J].中华消化内镜杂志,2015,32(7):476-477.
[3]仲恒高,缪林,季国忠,等.经胰管胆胰管隔膜预切开术留置导丝法和胰管支架法在困难性经内镜逆行胰胆管造影中的应用[J].临床肝胆病杂志,2015,31(12):2070-2072.
[4]孙雄,龚镭,彭晓斌,等.经胰管胆胰管隔膜切开术及双导丝术在困难性插管ERCP中的应用及安全性分析[J].中国内镜杂志,2017,23(8):47-50.
[5]梁运啸,梁列新,农兵,等.针状刀预切开治疗胆管插管困难疾病52例[J].世界华人消化杂志,2014,22(8):1153-1156.
[6]Navaneethan U,Konjeti R,Venkatesh PG,et al.Early precut sphincterotomy and the risk of endoscopic retrograde cholangiopancreatography related complications:An updated Metaanalysis[J].World J Gastrointest Endosc,2014,6(5):200-208.
[7]Tang Z,Yang Y,Yang Z,et al.Early precut sphincterrrrotomy does not increase the risk of adverse events for patients with difficult biliary access[J].Medicine,2018,97(36):e12213.
[8]Choudhary A,Winn J,Siddique S,et al.Effect of precut sphincterotomy on post-endoscopic retrograde cholangiopancreatography pancreatitis:A systematic review and Meta-analysis[J].World J Gastroenterol,2014,20(14):4093-4101.