对于困难插管的患者,胰管支架占据法导丝引导插管增加针刀预切开的需求

时间:2019-10-26 作者:翻译:于廷廷 审校: 点击:

Wire-guided cannulation over a pancreatic stent method increases the need for needle-knife precutting ın patients with difficult biliary cannulations
对于困难插管的患者,胰管支架占据法导丝引导插管增加针刀预切开的需求
 
Background and Aims: Cannulation of the major papilla can be problematic, and selective biliary cannulation may fail in up to 18% of cases. Various techniques, such as double-guidewire technique (DGWT), wire-guided cannulation over a pancreatic stent (WGC-PS), the precut endoscopic sphincterotomy (needle-knife precutting technique (NKP), and transpancreatic septostomy have been used to improve the success rate of biliary cannulation. We conducted a prospective, randomized study in order to compare the biliary cannulation success rates of DGWT and WGC-PS techniques in patients with inadvertent passage of guidewire to the pancreatic duct.
背景与目的:主乳头的插管可能会出现困难,选择性胆管插管可能失败的病例多达18%。 多种插管技术,例如双导丝法(DGWT),胰腺支架占据法(WGC-PS),括约肌切预开技术(针刀预切法(NKP)和经胰管预切开法)已被用来提高胆管插管的成功率。我们进行了一项前瞻性随机研究,以比较DGWT和WGC-PS技术在无意间将导丝插入胰管的患者中的胆管插管成功率。
 
Methods: A total of 100 patients were included in the study and randomized to DGWT (n=50) or WGC-PS (n=50) groups. The primary outcome was successful selective cannulation, defined as deep cannulation with selective injection of radiographic contrast material into the common bile duct within 5 minutes by DGW or WGC-PS techniques without performing precut sphincterotomy.
方法:本研究共纳入100名患者,随机分为DGWT组(n= 50)或WGC-PS组(n= 50)。 主要结局指标是成功的选择性插管,定义为通过DGW或WGC-PS技术在5分钟内将造影剂选择性地注入胆总管而无需进行括约肌预切开术的深部插管。
 
Results: Successful selective cannulation was achieved in 45 patients in the DGWT group (90%) and in 27 patients in the WGC-PS group (54%) (P < .001). Five patients (10%) in the DGWT group and 23 (46%) in the WGC-PS group required NKP for biliary access (P < .001). The overall cannulation rate was 98% for DGWT and 98% for WGC-PS (P Z 1.00).
结果:DGWT组的45例患者(90%)和WGC-PS组的27例患者(54%)成功选择性插管(P <.001)。 DGWT组有5例患者(10%),WGC-PS组有23例(46%)需要通过NKP进行胆道造瘘(P <.001)。 DGWT的总插管率为98%,WGC-PS的总插管率为98%(P =1.00)。
 
Conclusions: In patients with unintentional passage of a guidewire into the pancreatic duct during biliary cannulation attempts, the WGC-PS technique significantly increased the need for NKP compared with DGWT.
结论:在胆道插管无意将导丝插入胰管的患者中,与双导丝法相比,胰管支架占据法明显增加了对针刀预切开的需求。

Eminler, Ahmet Tarık, Parlak E , Koksal, Aydın Seref, et al. Wire-guided cannulation over a pancreatic stent method increases the need for needle-knife precutting ın patients with difficult biliary cannulations[J]. Gastrointestinal Endoscopy, 2018.
翻译:于廷廷 审校:张立超 侯森林