全球精选文摘 - 导丝引导的插管法可预防ERCP术后胰腺炎吗？一项前瞻性随机试验

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导丝引导的插管法可预防ERCP术后胰腺炎吗？一项前瞻性随机试验

Can wire-guided cannulation prevent post-ERCP pancreatitis? A prospective randomized trial

Lee TH, Park DH, Park J-Y 2009/9/21 19:30:53

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Gastrointest Endosc, 2009,

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Background:
Among the procedure-related factors associated with post-ERCP pancreatitis, selective cannulation of the common bile duct by insertion of a guidewire may be associated with fewer complications than conventional methods of cannulation with contrast injection to access the bile duct. However, the results of studies regarding the usefulness of wire-guided cannulation (WGC) are conflicting.

Objective:
This prospective randomized trial was designed to determine whether WGC reduces the rate of post-ERCP pancreatitis.

Design:
A prospective randomized controlled trial.

Setting:
Tertiary-care academic medical center.

Patients:
A total of 300 consecutive patients with native papilla and pancreaticobiliary disease who were candidates for therapeutic ERCP were randomized from June 2006 to May 2007.

Interventions:
WGC without contrast injection or conventional cannulation with contrast injection.

Main Outcome Measurements:
Post-ERCP pancreatitis, risk factors, and procedure-related complications were evaluated prospectively.

Results:
A total of 3 patients (2%) in the WGC group and 17 patients (11.3%) in the conventional group had post-ERCP pancreatitis (P=.001). Among the cases of acute pancreatitis in the WGC group, 2 patients with suspected sphincter of Oddi dysfunction (SOD) and unintentional main pancreatic duct (PD) guidewire cannulation showed post-ERCP pancreatitis despite the use of WGC. In multivariate analysis, WGC was a protective factor (odds ratio 0.1; 95% CI, 0.024-0.490, P=.004), whereas female sex and SOD were risk factors for post-ERCP pancreatitis.

Limitation:
Our study population was a low-risk cohort.

Conclusions:
WGC is associated with a lower rate of post-ERCP pancreatitis. However, WGC may not prevent post-ERCP pancreatitis in patients with suspected SOD and unintentional PD guidewire cannulation.

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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