不同辅助插管对插管困难型内镜逆行胰胆管造影术插管效果及术后急性胰腺炎的影响因素分析

doi:10.3969/j.issn.1006-6233.2022.07.017

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摘要 目的: 研究不同辅助插管对插管困难型内镜逆行胰胆管造影术插管效果及术后急性胰腺炎的影响因素。方法: 选取2018年10月到2021年12月来我院收治的94例患者作为研究对象,进行回顾性分析,依照患者不同辅助插管方式进行分组,分别为导丝组(36例,双导丝插管法)、针状组(30例,针状刀乳头预切开法)、经胰组(经胰管乳头预切开法)。观察三组患者的插管成功、插管时间、术后血淀粉酶临床效果情况。比较三组患者急性胰腺炎、多次插管、球囊扩张等不良事件情况,并分析研究急性胰腺炎影响因素。结果: 治疗效果:导丝组、针状组、经胰组于插管成功(分别为55.6%、93.3%、71.4%,χ²=11.688,P=0.003)、术后血淀粉酶(分别为526.35±213.54U/L、186.35±53.54U/L、289.45±136.68U/L,F=42.197,P<0.001)差异有统计学意义;插管时间差异无统计学意义(P>0.05)。不良事件情况:三组患者急性胰腺炎(8.3%、26.7%、10.7%)、多次插管(16.7%、33.3%、17.9%)、球囊扩张(19.4%、26.7%、21.4%)发生率差异无统计学意义(P>0.05)。急性胰腺炎单因素筛查中,多次插管(OR=4.714,95%CI:1.426~15.588)、球囊扩张(OR=4.714,95%CI:1.426~15.588)、预防性用药(OR=0.030,95%CI:0.007~0.132)差异具有统计学意义(P<0.05)。二元logisitc多因素回归得到影响急性胰腺炎发生的独立危险因素主要有预防性用药(OR=0.001,95%CI:0.000~0.043)、年龄(OR=1.191,95%CI:0.990~1.433)、插管时间(OR=0.308,95%CI:0.116~0.820)、血淀粉酶(OR=1.168,95%CI:1.041~1.311)。结论: 插管成功率上,针状刀乳头预切开法最优,经胰管乳头预切开法次之,双导丝插管法垫底;ERCP术后影响急性胰腺炎的独立危险因素为多次插管、球囊扩张、预防性用药、年龄、插管时间、血淀粉酶。

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	朱江源
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关键词 ：辅助插管, 插管困难型内镜逆行胰胆管造影术, 插管效果, 术后急性胰腺炎

Abstract：Objective: To study the effect of different auxiliary intubation on the intubation effect of difficult intubation endoscopic retrograde cholangiopancreatography and the influencing factors of postoperative acute pancreatitis. Methods: Ninety-four patients admitted to our hospital from October 2018 to December 2021 were selected for retrospective analysis and grouped according to the different auxiliary intubation methods of the patients,namely the guidewire group (36 patients,double guidewire intubation method),needle group (30 patients,needle knife nipple pre-incision method) and trans-pancreatic group (trans-pancreatic duct nipple pre-incision method).The intubation success,intubation time and postoperative clinical effect of blood amylase were observed in the three groups.The adverse events such as acute pancreatitis,multiple intubation and balloon dilation were compared among the three groups,and the influencing factors of acute pancreatitis were analyzed and studied. Results: Treatment effect:The differences in successful intubation (55.6%,93.3% and 71.4%,respectively,χ²=11.688,P=0.003) and postoperative blood amylase (526.35±213.54 U/L,186.35±53.54 U/L and 289.45±136.68 U/L,respectively,F=42.197,in the guide wire,needle and trans-pancreatic groups.P<0.001) was statistically significant; the difference in intubation time was not statistically significant (P>0.05).Adverse event profile:The differences in the incidence of acute pancreatitis (8.3%,26.7%,10.7%),multiple intubations (16.7%,33.3%,17.9%) and balloon dilation (19.4%,26.7%,21.4%) were not statistically significant (P>0.05) between the three groups of patients.The differences in univariate screening for acute pancreatitis were statistically significant (P<0.05) for multiple intubations (OR=4.714,95% CI:1.426 to 15.588),balloon dilation (OR=4.714,95% CI:1.426 to 15.588),prophylactic medication (OR=0.030,95% CI:0.007 to 0.132).Binary logisitc multifactorial regression yielded independent risk factors affecting the development of acute pancreatitis,mainly prophylactic medication (OR=0.001,95% CI:0.000-0.043),age (OR=1.191,95% CI:0.990-1.433),time to intubation (OR=0.308,95% CI:0.116-0.820),blood amylase 0.820),blood amylase (OR=1.168,95%CI:1.041~1.311). Conclusion: The success rate of intubation was best with needle knife nipple preincision,followed by trans-pancreatic duct nipple preincision and bottom with double guidewire intubation; independent risk factors affecting acute pancreatitis after ERCP were multiple intubations,balloon dilation,prophylactic medication,age,time of intubation and blood amylase.

Key words： Auxiliary intubation Endoscopic retrograde cholangiopancreatography with difficult intubation Intubation effect Postoperative acute pancreatitis

基金资助:安徽省重点研究与开发计划立项项目,(编号:201904a07020021);安徽省宣城市人民医院科技技术项目(编号:KY202116)

引用本文:

朱江源, 黄志刚, 王光明. 不同辅助插管对插管困难型内镜逆行胰胆管造影术插管效果及术后急性胰腺炎的影响因素分析[J]. 河北医学, 2022, 28(7): 1135-1141.
ZHU Jiangyuan, HUANG Zhigang, WANG Guangming. Analysis of the Effect of Different Auxiliary Intubation on Difficult Intubati on Endoscopic Retrograde Cholangiopancreatography and the Influencing Factors of Postoperative Acute Pancreatitis. HeBei Med, 2022, 28(7): 1135-1141.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2022.07.017 或 http://www.hbyxzzs.cn/CN/Y2022/V28/I7/1135

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