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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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

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	ZHU Jiangyuan
	HUANG Zhigang
	WANG Guangming

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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[J]. HeBei Med, 2022, 28(7): 1135-1141.

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

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