经胰管括约肌切开联合胰管支架植入在ERCP困难插管中的应用

doi:10.3877/cma.j.issn.2095-3232.2020.04.012

目的

探讨经胰管括约肌切开（TPS）联合胰管支架植入（PSO）在ERCP困难插管中的应用价值。

方法

回顾性分析2015年3月至2019年5月在上海中医药大学附属曙光医院行ERCP的224例胆道疾病患者临床资料。其中男114例，女110例；平均年龄（67±9）岁。患者均签署知情同意书，符合医学伦理学规定。根据不同插管方法将患者分为TPS+PSO组（135例）和对照组（89例）。观察两组患者插管操作时间、术中插管成功率、术后并发症发生率和住院费用等。两组住院时间、住院费用比较采用t检验；率的比较采用χ²检验。

结果

TPS+PSO组胆管插管成功率为93%（125/135），明显高于对照组的73%（65/89）（χ²=15.938，P<0.05），而插管时间（25±10）min明显低于对照组的（37±14）min（t=-3.927，P<0.05）。TPS+PSO组术后胰腺炎和出血发生率分别为11%（15/135）、1%（2/135），明显低于对照组的25%（22/89）、7%（6/89）（χ²=7.203，4.309；P<0.05）。TPS+PSO组和对照组住院费用分别为（2.1±0.5）、（3.2±0.7）万元，差异无统计学意义（t=-1.072，P>0.05）。

结论

TPS联合PSO可提高ERCP胆管困难插管成功率，降低术后胰腺炎发生率，具有操作时间短的优势，且不增加住院费用，是一种安全实用、方便可行的内镜技术。

关键词: 胰胆管造影术，内窥镜逆行, 经胰管括约肌切开, 胰管支架植入

Objective

To explore the application of transpancreatic sphincterotomy (TPS) combined with pancreatic stent occupation (PSO) in difficult intubation of endoscopic retrograde cholangiopancreatography (ERCP).

Methods

Clinical data of 224 patients with biliary tract disease who underwent ERCP from March 2015 to May 2019 at Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine were retrospectively analyzed. Among them, 114 were male and 110 female, with a mean age of (67±9) years. The informed consents of all patients were obtained and the local ethical committee approval was received. Patients were assigned to TPS+PSO group (n=135) and control group (n=89) according to different intubation. The duration of intubation, intraoperative intubation success rate, incidence of postoperative complication and hospitalization costs of both groups of patients were recorded. Comparisons of length of hospital stay and cost between two groups were performed using t test and comparisons of rates were performed using Chi-square test.

Results

The success rate of biliary intubation in TPS+PSO group was 93% (125/135), which was significantly higher than 73% (65/89) in control group (χ²=15.938, P<0.05), and the duration of intubation was (25±10) min, which was significantly shorter than (37±14) min in control group (t=-3.927, P<0.05). The incidence of postoperative pancreatitis and bleeding in TPS+PSO group was 11% (15/135) and 1% (2/135), respectively, which were significantly lower than 25% (22/89) and 7%(6/89) in control group (χ²=7.203, 4.309; P<0.05). The hospitalization costs in TPS+PSO group and control group were (21±5) and (32±7) thousand Yuan, respectively, no significant difference was observed (t=-1.072, P>0.05).

Conclusions

TPS combined with PSO can improve the success rate in difficult intubation of ERCP and reduced the incidence of postoperative pancreatitis, with the advantages of shortened the operating time without increase of hospital cost, which is a safe, practical, and feasible endoscopic technique.

Key words: Cholangiopancreatography, endoscopic retrograde, Transpancreatic sphincterotomy, Pancreatic stent occupation

图1 一例患者ERCP术中胆管困难插管操作图

表1 TPS+PSO组和对照组ERCP胆管困难插管患者术前情况比较

组别	例数	性别（例）		年龄（岁，±s ）	ASA分级（例）		BMI （kg/m²，±s ）
组别	例数	男	女	年龄（岁，±s ）	Ⅰ、Ⅱ级	Ⅲ级以上	BMI （kg/m²，±s ）
TPS+PSO组	135	73	62	63±12	113	22	26±6
对照组	89	41	48	73±9	71	18	29±5
统计值	?	χ²=1.376		t=-1.632	χ²=0.564		t=-1.254
P值	?	>0.05		>0.05	>0.05		>0.05

表1 TPS+PSO组和对照组ERCP胆管困难插管患者术前情况比较

组别	例数	性别（例）		年龄（岁，±s ）	ASA分级（例）		BMI （kg/m²，±s ）
组别	例数	男	女	年龄（岁，±s ）	Ⅰ、Ⅱ级	Ⅲ级以上	BMI （kg/m²，±s ）
TPS+PSO组	135	73	62	63±12	113	22	26±6
对照组	89	41	48	73±9	71	18	29±5
统计值	?	χ²=1.376		t=-1.632	χ²=0.564		t=-1.254
P值	?	>0.05		>0.05	>0.05		>0.05

表2 TPS+PSO组和对照组ERCP胆管困难插管患者围手术期情况比较（±s ）

组别	例数	插管时间（min）	CRP（mg/L）	IL-6（ng/L）	进食时间（h）	住院时间（d）	住院费用（万元）
TPS+PSO组	135	25±10	30±5	46±12	34±13	5.1±1.4	2.1±0.5
对照组	89	37±14	38±8	88±33	42±21	7.2±2.6	3.2±0.7
t值	?	-3.927	-1.562	-2.778	-1.039	-2.156	-1.072
P值	?	<0.05	>0.05	<0.05	>0.05	>0.05	>0.05

表2 TPS+PSO组和对照组ERCP胆管困难插管患者围手术期情况比较（±s ）

组别	例数	插管时间（min）	CRP（mg/L）	IL-6（ng/L）	进食时间（h）	住院时间（d）	住院费用（万元）
TPS+PSO组	135	25±10	30±5	46±12	34±13	5.1±1.4	2.1±0.5
对照组	89	37±14	38±8	88±33	42±21	7.2±2.6	3.2±0.7
t值	?	-3.927	-1.562	-2.778	-1.039	-2.156	-1.072
P值	?	<0.05	>0.05	<0.05	>0.05	>0.05	>0.05

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Transpancreatic sphincterotomy combined with pancreatic duct stenting for difficult intubation of ERCP

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Transpancreatic sphincterotomy combined with pancreatic duct stenting for difficult intubation of ERCP