Cause Analysis And Countermeasure Research Of Difficult Selective Biliary Cannulation

Background:Endoscopic retrograde cholangiopancreatography(ERCP)has been widely used in the diagnosis and treatment of cholangiopancreatography due to its unique advantages such as small trauma and quick recovery.Selective biliary intubation is a difficult part of ERCP operation.How to improve the success rate of intubation and reduce postoperative complications remains the focus of attention of endoscopes.Objective:To analyze the related factors causing difficult intubation of bile duct,the success rate of assisted intubation technique and the incidence of postoperative complications,and provide guidance for the ERCP safety operation of clinicians.Methods:All the first clinical cases of ERCP biliary tract intervention were collected from the First Affiliated Hospital of Nanchang University from January 2008 to December2017,and a retrospective survey was carried out.Pearson X2 test or Fisher exact probability method was used to analyze the disease related factors of patients with choledocholithiasis,malignant stricture of bile duct,benign stricture of bile duct,duodenal papilla or periampullary tumor,and biliary ascariasis,and the relative factors of the anatomy: the thick length of the duodenal papilla,the papilla in the diverticulum,the nipple in the diverticulum,and the nipple There was no statistically significant difference in the rate of difficult intubation between position,papillae,nipple ulceration,and type II excision.There was no difference in success rate between various catheterization techniques after difficult intubation,and whether there was any difference in postoperative complications.Results:1.After preliminary screening of 17445 cases of ERCP patients,11274 cases were in conformity with the inclusion criteria,of which 916 cases were selective in selective bile duct intubation and 8.12%(916/11274)with difficult intubation.141 cases of intubation failed and the rate of intubation was 1.25%(141/11274)afterremedial measures in 916 cases.The rate of difficult catheterization caused by various diseases and anatomical factors was statistically different.Of the 916 cases,876 cases were used in assisted intubation,435 cases were guided wire(stent)occupation and 435 cases of pancreatic duct Preincision,the success rate was 91.5%,the guide wire(stent)occupation method + Preincision of the pancreatic duct + needle knife Preincision was 18 cases,the success rate was 94.4%,the needle knife Preincision was 225,the success rate was 87.6%;the pancreatic duct plastic stent was accounted for.According to the 46 cases,the success rate was 87%,the duodenal papilla was opened in 53 cases,the success rate was 90.6%,the guide wire occupied 37 cases,the success rate was 94.6%,the two times ERCP 62 cases,the success rate was 92%.There was no significant difference in the success rate between the 7 groups(P < 0.05).Postoperative complications included:(1)77 cases of hyperamylase after operation,the total incidence was 9.5%;(2)52 cases of postoperative pancreatitis,the total incidence was 6%,and there was no statistical difference between 7 operation techniques(3)(3)postoperative infection altogether 40 cases,the total incidence was4.6%,7 kinds of operation techniques had no statistical difference.(P < 0.05);(4)there were 12 cases of bleeding in total,the total incidence was 1.5%;(5)3 cases of intestinal perforation,the total incidence was 0.4%;(6)there were 713 cases without complications,the total incidence was 81.4%,and there were statistically significant differences between the 7 operation techniques(P=0.002 < 0.05);the incidence of total complications in the group used alone or combined with needle knife technique.The higher the rate of complication is,the higher the complication rate is.Conclusion:The rate of difficult intubation caused by various diseases and dissecting factors is statistically different,the success rate of different assisted intubation techniques is not statistically different,and there is no statistical difference between the postoperative complications of different difficult bile duct intubation techniques,the incidence of total complications is statistically significant,and the pre incision of needle knife and the incidence of the complications are statistically significant.The complication rate is higher.