山东医药

目的 比较超滑导丝与直头斑马导丝在胆总管结石患者内镜逆行胰胆管造影术（ERCP）插管中的应用效果，为临床选择导丝类型提供依据。方法 回顾性纳入接受ERCP治疗的胆总管结石患者110例为研究对象，其中采用超滑导丝进行ERCP插管的患者47例，采用直头斑马导丝进行ERCP插管的患者63例。采用倾向性评分匹配法以1∶1比例进行匹配后，最终纳入超滑导丝组45例、直头斑马导丝组45例。观察两组患者插管效果，包括插管成功率、插管时间、插管尝试次数；术后恢复情况，包括术后6 h血清淀粉酶水平、术后6 h总胆红素水平、术后首次排气时间、住院时间；术后并发症发生情况，包括术后胰腺炎、胆管炎、出血、消化道穿孔等，计算并发症总发生率。结果 超滑导丝组插管成功率为97.78%(44/45)、插管时间（4.38±1.21）min、插管尝试次数（1.58±0.63）次，直头斑马导丝组插管成功率为88.89%(40/45)、插管时间（6.72±1.84）min、插管尝试次数（2.46±0.89）次，其中超滑导丝组插管时间、插管尝试次数均低于直头斑马导丝组（P均<0.05）。两组患者术后6 h血清淀粉酶水平、术后6 h总胆红素水平、术后首次排气时间、住院时间相比，P均>0.05。超滑导丝组术后并发症总发生率低于直头斑马导丝组（P<0.05）。结论 在胆总管结石患者ERCP插管中，超滑导丝与直头斑马导丝的插管成功率相当，但超滑导丝可显著缩短插管时间、减少插管尝试次数并降低ERCP相关并发症发生率。

Objective To compare the application effects of super-slippery guidewire and straight-tip zebra guidewire in cannulation during endoscopic retrograde cholangiopancreatography(ERCP) for patients with common bile duct stones, providing a basis for clinical selection of guidewire types.Methods A retrospective study included 110 patients with common bile duct stones undergoing ERCP treatment as the research subjects, comprising 47 cases using super-slippery guidewires and 63 cases using straight-tip zebra guidewires.After propensity score matching at a 1:1 ratio, 45 cases in the super-slippery guidewire group and 45 cases in the straight-tip zebra guidewire group were ultimately enrolled.The cannulation outcomes, including cannulation success rate, cannulation time, and the number of cannulation attempts; postoperative recovery, including serum amylase levels at 6 h postoperatively, total bilirubin levels at 6 h postoperatively, time to first flatus, and hospital stay; and postoperative complications, including postoperative pancreatitis, cholangitis, bleeding, and gastrointestinal perforation, were observed.The total complication rate was calculated.Results The super-slippery guidewire group achieved a cannulation success rate of 97.78%(44/45), with a cannulation time of(4.38 ± 1.21) minutes and a number of cannulation attempts of 1.58 ± 0.63.The straight-tip zebra guidewire group had a cannulation success rate of 88.89%(40/45), a cannulation time of(6.72 ± 1.84) minutes, and a number of cannulation attempts of 2.46±0.89.The super-slippery guidewire group exhibited significantly shorter cannulation time and fewer cannulation attempts as compared with the straight-tip zebra guidewire group(all P<0.05).There were no significant differences in serum amylase levels at 6 h postoperatively, total bilirubin levels at 6 h postoperatively, time to first flatus, or hospital stay between the two groups(all P>0.05).The total complication rate in the super-slippery guidewire group was lower than that in the straight-tip zebra guidewire group(P<0.05).Conclusion In ERCP cannulation for patients with common bile duct stones, the cannulation success rates of super-slippery guidewires and straight-tipped zebra guidewires are comparable, but super-slippery guidewires can significantly reduce cannulation time, decrease the number of cannulation attempts, and lower the incidence of ERCP-related complications.