可拆卸钛夹联合橡皮圈辅助内镜逆行胰胆管造影术在困难胆管插管中的临床应用

目的 评价可拆卸钛夹联合橡皮圈辅助内镜逆行胰胆管造影术（ERCP）在合并憩室内乳头的困难胆管插管中的疗效和安全性。方法 回顾性分析2020年3月－2021年10月因各种胆道疾病在该院行ERCP的869例患者的临床资料，对困难胆管合并憩室内乳头初始行常规插管失败的127例患者，使用可拆卸钛夹联合橡皮圈辅助技术再次行胆管插管，观察患者胆管插管成功率、辅助后插管成功时间和术后并发症发生率等情况。结果 困难插管患者127例（14.61%，127/869）。其中，14例合并有憩室内乳头的困难插管患者，经常规插管方法无法进入胆管，采用可拆卸钛夹联合橡皮圈的辅助技术再次进行胆管插管后，13例（92.86%）患者插管成功，插管时间（6.23±2.87）min，1例尝试数次仍未能进入胆管。术后2例发生高淀粉酶血症，1例发生轻度胰腺炎，无其他并发症发生。结论 可拆卸钛夹联合橡皮圈的辅助技术用于合并有憩室内乳头的困难胆管插管患者，安全、有效。值得临床应用推广。

Clinical application of detachable titanium clip combined with rubber band in biliary intubation of difficult bile duct with ERCP

Objective To evaluate clinical efficacy and safety of endoscopic application of detachable titanium clip and rubber-band traction in difficult biliary cannulation patients with the papilla of vater in the diverticula during endoscopic retrograde cholangiopancreatography (ERCP).Methods The clinical data of 869 patients with biliary tract diseases who underwent ERCP from March 2020 to October 2021 were retrospectively analyzed. 127 patients with difficult bile ducts combined with the papilla of vater in the diverticula who failed in the intial routine intubation were selected. Subsequently, these patients who used the removable detachable titanium clip combined with rubber-band traction to re-intubation of bile duct were analyzed. The main observation indicators included success rate of bile duct intubation, operation time and post-operative complications.Results There were 127 (14.61%, 127/869) patients with difficult biliary cannulation, and 14 patients with difficult biliary cannulation and the papilla of vater in the diverticula were still unable to enter the bile duct after routine intubation. and then they were intubated again with the auxiliary technology of detachable titanium clip combined with rubber-band traction, and the 13 patients (92.86%) were successfully. The mean operation time was (6.23±2.87) min, post-ERCP hyperamylasemia occurred in 2 patients and mild pancreatitis occurred in 1 patients, without other complications.Conclusion Detachable titanium clip and rubber-band traction is a safe and feasible method for difficult biliary cannulation patients with the papilla of vater in the diverticula during ERCP. It is worthy of clinical application.