Application of transprepancreatic septotomy combined with modified pancreatic duct stent in ERCP difficult intubation of common bile duct stones

doi:10.3969/j.issn.1009-976X.2023.01.001

Abstract

Abstract: Objective To explore transprepancreatic septotomy combined with modified pancreatic duct stent procedure for treatment ofcommon bile duct stones in patients with ERCP difficult intubation. Methods The data of 60 patients with difficult intubation who underwent ERCP for choledocholithiasis from January 2020 to December 2021 in our hospital were retrospectively analyzed, and the effects and postoperative complications in ERCP difficult intubation patients were analyzed and compared between simple transprepancreatic septotomy （TPS） and transprepancreatic septotomy combined with modified pancreatic duct stent technique （TPS+MPs）. Results There was no significant difference in gender, age, height, weight, BMI and liver function between TPS group （n=29） and TPS+MPs group （n=31）. Patients in TPS+MPs group showed lower WBC count, post-ERCP pancreatitis incidence, and total complication incidence, and compared to those in TPS group, there were significant differences （all Ps less than 0.05）. There was no significant difference in the success rate of intubation and the success rate of one-time lithotomy. Two patients were found gastrointestinal bleeding in TPS group and no one in TPS+mPS group. No perforation occurred in both groups. Conclusion It is safe and effective to apply the transprepancreatic septotomy combined with modified pancreatic duct stent for treatment of common bile duct stones in patients with ERCP difficult intubation.

Key words: transprepancreatic septotomy, modified pancreatic duct stent, difficult intubation, ERCP, complication

摘要： 目的探讨经胆胰隔膜切开联合改良胰管支架技术在胆总管结石行ERCP取石困难插管中的应用效果。方法回顾性分析我院2020年1月至2021年12月间胆总管结石行ERCP取石的困难插管的60例患者的资料,分析比较单纯经胆胰隔膜切开（TPS）及经胆胰隔膜切开联合改良胰管支架技术（TPS+mPS）解决困难插管的效果及术后并发症发生情况。结果 TPS组与TPS+mPS组在性别、年龄、身高、体重、BMI、肝功能等方面比较差异无统计学意义;在插管成功率,一次性取石成功率方面比较差异无统计学意义;TPS+mPS组在外周血WBC（×10⁹/L）水平、术后胰腺炎发生率、总并发症发生率均低于单纯TPS组（P<0.05）。TPS组有2例术后发生消化道出血,TPS+mPS组无出血病例;两组均无穿孔病例发生。结论经胆胰隔膜切开联合改良胰管支架技术在胆总管结石行ERCP取石困难插管的患者中应用是安全有效的。

关键词: 经胆胰隔膜切开, 改良胰管支架, 困难插管, ERCP术后胰腺炎, 内窥镜逆行胰胆管造影术

CLC Number:

R657.4

JIAO Yuan-jun, LIN Qi-rui, YIN Yao-xin, LI Gui-xian, LIU Xiao-ping. Application of transprepancreatic septotomy combined with modified pancreatic duct stent in ERCP difficult intubation of common bile duct stones[J]. Lingnan Modern Clinics In Surgery, 2023, 23(01): 1-5.

矫元君, 林齐睿, 尹耀新, 李桂贤, 刘晓平. 经胆胰隔膜切开联合改良胰管支架技术在胆总管结石行ERCP取石困难插管中的应用[J]. 岭南现代临床外科, 2023, 23(01): 1-5.

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