双导丝技术与经胰管预切开术在插管困难型内镜逆行胰胆管造影术中
·26·中华消化病与影像杂志（电子版）2014年10月第4卷第5期Chin J Digest Med Imageol（Electronic Edition），October2014，Vol．4，No．5
·临床研究·双导丝技术与经胰管预切开术在插管困难型
内镜逆行胰胆管造影术中应用的比较研究
宗伟高峰刘贵生朱云清
【摘要】目的比较双导丝技术（DGT）和经胰管预切开术（TPS）在插管困难型内镜逆行胰胆管
造影术（EＲCP）中应用的疗效和安全性。方法回顾性分析2008年1月至2013年7月在陕西省人民
医院行EＲCP治疗的613例患者，共71例患者胆管插管困难、导丝反复进入胰管。其中34例患者行
DGT，37例患者行TPS。采用χ2检验比较DGT组与TPS组插管成功率以及相关术后并发症如急性胰腺
炎、高淀粉酶血症发生率，采用t检验比较DGT组与TPS组插管时间。结果DGT组插管成功率为
88%（30/34），TPS组插管成功率为87%（32/37），两者差异无统计学意义（χ2=0．049，P=0．0954）；DGT
组插管时间为（12．6?14．2）min，TPS组插管时间为（13．4?15．9）min，两者差异无统计学意义（t=
0．2084，P=0．8356）。DGT组术后胰腺炎发生率为27%（9/34），高于TPS组术后胰腺炎发生率8%
（3/37），且差异有统计学意义（χ2=4．254，P=0．039）；DGT组术后高淀粉酶血症发生率为32%
（11/34），TPS组术后高淀粉酶血症发生率为30%（11/37），两者差异无统计学意义（χ2=0．057，
P=0．811）。TPS组1例患者发生十二指肠穿孔，而DGT组无一例患者发生十二指肠穿孔。结论当
选择性胆管插管困难时，DGT和TPS均可明显提高插管成功率，TPS插管成功率略高于DGT，DGT术后
胰腺炎发生率高于TPS，TPS则有并发十二指肠穿孔的风险。
【关键词】胰胆管造影术，内窥镜逆行；双导丝技术；经胰管预切开术
Comparative study on the applications of double guidewire technique and transpancreatic precut
sphincterotomy in the difficult endoscopic retrograde cholangiopancreatography Zong Wei，Gao Feng，
Liu Guisheng，Zhu Yunqing．Department of Gastroenterlogy，Shanxi Provincial People's Hospital，Xi'an
710068，China
Corresponding author：Zong Wei，Email：iamzongwei@163．com
【Abstract】Objective To compare the outcomes between double-guidewire technique（DGT）and
transpancreatic precut sphincterotomy（TPS）in patients with difficult endoscopic retrograde cholangiopancreatography（EＲCP）．Methods This was a retrospective analysis on613patients treated using
EＲCP between January2008and July2013in the Shanxi Provincial People's Hospital．A total of71patients
were picked out due to unavailable cystic duct cannula or repeated in-out pancreatic duct of the guide wire，
with34patients treated using DGT and37patients using TPS．Chi-square test was used to compare the
success rate of cannula and incidence rate of associated postoperative complications（such as acute
pancreatitis，hyperamylasemia），t-test was used to compare between-group difference in the time of cannula．
Ｒesults There were no significant statistical differences of between-group success rate of cannula（χ2=
0．049，P=0．0954），with DGT group88%（30/34）and TPS group87%（32/37）．And also no
significant differences were found in time of cannula（t=0．2084，P=0．8356），with DGT group（12．6?
14．2）minutes and TPS group（13．4?15．9）minutes．The incidence rate of acute pancreatitis differed
significantly between both groups（χ2=4．254，P=0．039），with DGT group27%（9/34）significant
higher than that in TPS group8%（3/37）；while no significant differences were found in incidence rate of
hyperamylasemia（χ2=0．057，P=0．811），with DGT group32%（11/34）and TPS group30%（11/37）．
Furthermore，one case of duodenuml perforation occurred in TPS group，while none occurred in DGT group．
Conclusion Facing unavailable selective pancreatic duct cannulation，both of DGT and TPS could
significantly improve the success rate of cannula，with TPS a little higher than DGT，and the incidence rate
DOI：10．3877/cma．j．issn．2095-2015．2014．05．008
作者单位：710068西安，陕西省人民医院消化内科
通信作者：宗伟，Email：iamzongwei@163．com