经胰胆管括约肌切开、双导丝及胰管支架在ERCP困难插管中的联合应用

Usefulness of Transpancreatic Precut Sphincterotomy, Double Wire-Guided Technique and Pancreatic Stent-Assisted Techniques for Difficult Bile Duct Intubation in ERCP

摘要: 目的：探讨经胰胆管括约肌切开、双导丝及胰管支架在ERCP (endoscopic retrograde cholangiopancreatography，内镜逆行胰胆管造影术)困难插管中的联合应用。方法：回顾性分析本院2018年1月至2024年6月期间进行ERCP诊治胆胰疾病术中出现困难插管的患者267例。根据不同的治疗方案将其分为双导丝联合胰管支架(DWG + PS)，经胰胆管括约肌切开联合胰管支架(TPS + PS)及三者联合(DWG + TPS + PS)治疗组。三组患者均行ERCP。记录并比较三组患者的插管成功率及术后并发症发生率。结果：DWG + PS组患者的插管成功率为98.51%，明显高于TPS + PS组(84.13%)及DWG + TPS + PS组(90%) (P < 0.05)；三组之间的并发症发生率无统计学差异(P > 0.05)。结论：在本中心的回顾性分析中，DWG + PS联合技术在处理特定类型的困难插管时展现了很高的成功率。然而，由于研究存在显著的选择偏倚和混杂因素，该结果尚不能直接推广为所有困难插管场景下的首选策略。其相对于其他联合技术的真实优劣，亟待前瞻性随机对照研究(RCT)的验证。

Abstract: Objective: To analyze the usefulness of transpancreatic precut sphincterotomy, double wire-guided technique and pancreatic stent-assisted techniques for bile duct intubation in ERCP. Methods: From January, 2018 to June, 2024, at Affiliated Hospital of Qingdao University 267 patients with difficult bile duct intubation in ERCP were retrospectively analyzed. According to different ways of treatment, patients were divided into the combination group of double wire-guided technique and pancreatic stent-assisted techniques (DWG + PS), combination group of transpancreatic precut sphincterotomy and pancreatic stent-assisted techniques (TPS + PS), and combination group of three techniques (DWG + TPS + PS). The rate of successful deep biliary cannulation and the rate of postoperative complications were compared in the three groups. Result: The success rate of intubation in DWG + PS (98.51%) was higher than that in TPS + PS (84.13%) and DWG + TPS + PS (90%) (P < 0.05). There was no significant difference in postoperative complications in the three groups (P > 0.05). Conclusion: In this retrospective analysis from our center, the combined DWG + PS technique demonstrated a high success rate in managing specific types of difficult intubations. However, due to significant selection bias and confounding factors inherent in the study design, these findings cannot be directly generalized as the preferred strategy for all difficult airway scenarios. The true comparative efficacy of this technique relative to other combined approaches warrants further validation through prospective randomized controlled trials (RCTs).