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目的评价导丝占据胰管法在困难胆道插管中的临床应用价值。方法回顾性分析2007年1月-2009年12月在沈阳军区总医院内窥镜科行内镜逆行胰胆管造影(ERCP)患者的临床资料。对常规切开刀胆管插管失败且导丝反复进入胰管(>3次)者,将导丝留置于胰管内,重新插入切开刀,接近乳头后,利用抬钳器将留置的导丝轻轻向下压,将乳头固定,同时将胆管和胰管间的隔膜向胰管侧牵拉,使胆管和胰管开口稍分离,以利切开刀在胰管左上方11点方向寻找胆管开口,并在导丝的辅助下进行胆管深插管,胆管插管成功后,导丝留置胆管内,继续完成胆管括约肌切开及相应治疗。统计插管的成功率及并发症的发生率。结果共行ERCP 2318例次,需胆管深插管1579例次,利用导丝占据胰管法行胆管插管185例次,胆管深插管成功率95.1%(176/185),8例(4.3%)发生并发症,为高淀粉酶血症,无出血、穿孔、术后胰腺炎等严重并发症发生。结论在困难胆道插管中采用导丝占据胰管法行胆道深插管是一种安全有效的方法。
Objective To evaluate the clinical value of guide wire occupying pancreatic duct in difficult biliary intubation. Methods The clinical data of endoscopic retrograde cholangiopancreatography (ERCP) patients in Department of Endoscopy, Shenyang Military Region General Hospital from January 2007 to December 2009 were retrospectively analyzed. Conventional incision on the failed biliary cannulation and guide wire repeatedly into the pancreatic duct (> 3 times), the guide wire was placed in the pancreatic duct, re-insert the incision, close to the nipple, the use of the forceps will be placed in the guide wire Gently press down, the nipple fixed, while the diaphragm between the bile duct and pancreatic duct to pull the pancreatic duct, the bile duct and pancreatic duct opening slightly separated to facilitate cutting incision in the upper left 11 o’clock of the pancreatic duct to find the direction of the bile duct Opening and deep guide tube in the biliary catheter with the help of guide wire, after the bile duct intubation success, the guide wire indwelling bile duct, continue to complete the biliary sphincterotomy and the corresponding treatment. Statistics intubation success rate and the incidence of complications. Results A total of 2318 cases of ERCP were performed concurrently. A total of 1579 cases of deep biliary intubation were required. 185 cases of bile duct intubation were performed with guide wire, and the success rate of deep bile duct intubation was 95.1% (176/185) and 8 cases (4.3 %) Complications, high amylasemia, no bleeding, perforation, postoperative pancreatitis and other serious complications. Conclusion It is a safe and effective method to use the guidewire to take deep biliary intubation in difficult biliary intubation.