困难插管时的最佳预切开时间(译)

时间:2018-08-28 作者:翻译:张卫 审校: 点击:

困难插管时的最佳预切开时间(译)

背景和研究目的:
在ERCP中,当遇到困难插管时,预切开技术是经常被用到的一种方法。然而还没有共识指出开始预切开的最佳时间。
资料和方法:
从2009年至2016年,我们回顾性收集了63例患者的资料,这些患者在行ERCP过程中,因单纯乳头并且困难插管时采取了预切开的方法。分为早期预切开组(≤20分,从插管到开始预切开)和晚期预切开组(大于20分),对两组进行比较。
结果:
在63例患者中,16(27%)例患者属于早期预切开,47(73%)例属于晚期预切开。中位数时间(插管到开始切开时间)为28分钟(7-50)。两组之间的临床特点(年龄,性别,ERCP指征),预切开的方法和胰管支架置入率无统计学意义。有意义的是早期预切开组的(16/17; 94%)插管成功率高于晚期预切开组(32/46; 70%),(P<0.05)。并发现,有13例患者在40分钟后才开始预切开,插管的成功率低至53%(7/13),两组之间的ERCP术后并发症并无明显差异(5例胰腺炎患者,1例出血患者)。
结论:在实际的临床操作中,开始预切开的时间被认为在开始插管后接近30分钟时,然而,对于成功的插管,建议开始预切开的时间在20分钟内。当Vater壶腹部轻度炎症和水肿时,预切开技术是有效的。本研究的局限性是单中心的,回顾性的和小样本的研究。
                                 
 
Optimal timing for precutting in cases with difficult biliary cannulation
 
Optimal timing for precutting in cases with difficult biliary cannulation
Yuichi Takano, Masatsugu Nagahama, Fumitaka Niiya, et al. Endoscopy International Open 2018; 06: E1015–E1019
 
Background and study aims
In endoscopic retrograde cholangiopancreatography (ERCP), precutting is widely used when achieving biliary cannulation is difficult. How-ever, no consensus has been reached with regard to the best time to initiate precutting.
Patients and methods
We retrospectively examined 63 patients who underwent precutting for naïve papilla with difficulty in biliary cannulation between 2009 and 2016. The outcomes of the early precut group (≤20min from cannulation until initiating precutting) and the late precut group (>20min) were compared.
Results
Of the 63 patients, 17 (27%) were in the early precut group and 46 (73%) were in the late precut group; median time until the initiating precutting was 28 minutes (7–50). No significant difference was observed between
the two groups in terms of clinical features (age, sex, and indication for ERCP), precutting method, and rate of pancreatic duct stent placement. Significantly higher rates of successful biliary cannulation were observed in the early precut group (16/17; 94%) than in the late precut group
(32/46; 70%) (P<0.05). In 13 patients in whom precutting was commenced after 40 minutes, the rate of successful biliary cannulation was very low at 53% (7/13). No significant difference was found between the two groups in terms of incidence of complications (pancreatitis in 5 patients and bleeding in 1 patient).
Conclusion
In actual clinical practice, precutting is commenced approximately 30 minutes after cannulation; however, to successfully achieve biliary cannulation, precutting is recommended to be performed within 20 minutes. Precutting is effective when little inflammation and swelling of the ampulla of Vater is observed. This study was limited in that it was single-center, retrospective and had a small subject sample.


 翻译:张卫   审校:张立超、侯森林   (Endoscopy International Open  2018)