比较环形尖端导丝与直线尖端导丝引导胆管插管的前瞻性随机研究(翻译)

时间:2018-08-10 作者:翻译:胡越 审校:张 点击:

比较环形尖端导丝与直线尖端导丝引导胆管插管的前瞻性随机研究

摘要背景
导丝引导插管作为实现选择性胆管通路的实用技术已被广泛接纳,因为与常规造影辅助插管相比,这项技术明显提高了胆管插管成功率。与常规的直线尖端导丝不同,环形尖端导丝(LGW)具有封闭的末端回路,其可以促进导丝穿过胆管十二指肠壁内段的上皮褶皱而造成较少创伤。本研究旨在比较环形尖端导丝(LGW)和直线尖端导丝(SGW)在实现成功的选择性胆管插管方面的表现。
方法:
自2014年12月至2015年12月,我们在此项随机对照研究中对192例天生突起状乳头的患者进行了导丝引导胆管插管。患者被随机分配到LGW组(n=96)或者SGW组(n=96)。我们的研究方案不包括前10分钟内随机分组的导丝引导插管未成功而交换到另一组导丝的案例在内。
结果:
两组的初次插管成功率没有显著差异(LGW组:86.5%;SGW组:77.1%;p=0.134)。LGW组在导丝引导胆管插管过程中意外进入胰管的发生率和平均次数明显低于SGW组(LGW组:14.6%;SGW组28.1%;p=0.034;LGW组:0.2 ±0.5次;SGW组0.6 ±1.3次;p=0.007)。两组的术后胰腺炎发生率分别为LGW组:5.2%;SGW组:8.3%(p=0.567)。
结论:
环形尖端导丝引导胆管插管率与常规导丝相比无显著差异。使用环形尖端导丝在导丝引导胆管插管过程中无意识胰管插管的发生率上低于直线尖端导丝。


A prospective randomized study of loop-tip versus straight-tip guidewire in wire-guided biliary cannulation.
Abstract
BACKGROUND:
Wire-guided cannulation has been widely accepted as a useful technique for achieving selective biliary access because it has significantly increased the success rate of biliary cannulation compared with conventional contrast-assisted cannulation. Unlike conventional guidewires with a straight tip, a loop-tip guidewire (LGW) has a closed distal loop that may facilitate less traumatic access through the epithelial folds of the intra-duodenal biliary segments. The aim of this study was to compare the performance of a LGW with a straight-tip guidewire (SGW) in achieving successful selective biliary cannulation.
METHODS:
From December 2014 to December 2015, we performed 192 wire-guided biliary cannulations for a naïve papilla in a randomized controlled trial. Patients were randomly assigned to the LGW group (n = 96) or the SGW group (n = 96). Our study protocol did not include crossover to the other guidewire arm if randomized wire-guided cannulation proved unsuccessful within the first 10 min.
RESULTS:
There was no significant difference in primary successful biliary cannulation between the two groups (LGW group: 86.5%; SGW group: 77.1%; p = 0.134). The rate and the mean number of unintentional pancreatic duct cannulations during wire-guided biliary cannulation were significantly lower in the LGW group than in the SGW group (LGW group: 14.6%; SGW group: 28.1%; p = 0.034; LGW group: 0.2 ± 0.5; SGW group: 0.6 ± 1.3; p = 0.007). Post-ERCP pancreatitis developed in 5.2% of patients in the LGW group and 8.3% of patients in the SGW group (p = 0.567).
CONCLUSIONS:
The biliary cannulation rate of the LGW was not significantly different from those of conventional guidewires. Use of the LGW was associated with a lower rate of unintentional pancreatic duct cannulation during wire-guided biliary cannulation than use of the SGW.


翻译:胡越 审校:张立超 侯森林  (Surgical Endoscopy  2017)