副乳头插管在内镜逆行胰胆管造影中的应用:一项单中心回顾性研究OA

Objective To explore the application and value of minor papilla cannulation in endoscopic retrograde cholangiopancreatography(ERCP).Methods A retrospective study was conducted on patients who underwent minor papilla cannulation during ERCP at the First Hospital of Lanzhou University between July 2021 and July 2025.The disease composition,cannulation success rate,stone clearance rate,clinical symptom improvement and complications of patients were analyzed.Results A total of 55 patients were enrolled,52 cases(94.5%)of including chronic pancreatitis,44 cases(80.0%)of pancreatic duct stones,30 cases(54.5%)of pancreas divisum,27 cases(49.1%)of pancreatic duct stenosis,6 cases(10.9%)of pancreatic pseudocyst(10.9%),3 cases(5.5%)of periampullary malignancy,and 1 cases(1.8%)of pancreatic leakage,disconnected pancreatic duct syndrome,and meandering main pancreatic duct syndrome respectively.The cohort comprised 34 males and 21 females,aged 5 to 80 years,with a median age of 50.0(23.0,61.0)years.Duodenal minor papilla cannulation was attempted 79 times,accounting for 1.4%(79/5 797)of all ERCP procedures during the same period.Successful cannulation was achieved in 56 attempts,yielding an overall success rate of 70.9%(56/79).The median cannulation time was 6.0(3.0,11.5)minutes,while the median time for successful cannulation was 4.0(3.0,7.3)minutes.Fifty-one procedures were initial minor papilla cannulation attempts,with a success rate of 60.8%(31/51).Patients with pancreas divisum achieved the highest minor papilla cannulation success rate of 80.0%(36/45).Of the 44 patients with chronic pancreatitis and pancreatic duct stones who underwent ERCP via the minor papilla(totaling 61 procedures),the complete stone clearance rate was 37.7%(23/61).In patients with successful cannulation and treatment,the median preoperative abdominal pain Visual Analogue Scale(VAS)score significantly decreased from 4.0(3.0,5.0)to 1.0(1.0,3.0)at 24 hours postoperatively(Z=6.00,P<0.001).The overall postoperative pain relief rate via minor papilla cannulation was 60.8%(48/79),and the pain relief rate after initial minor papilla cannulation was 52.9%(27/51).Patients with pancreas divisum achieved the highest pain relief rate of 68.9%(31/45).Hyperamylasemia occurred in 1.3%and post-ERCP pancreatitis occurred in 8.9%.No cases of perforation or bleeding were observed.Conclusion Minor papilla cannulation holds significant clinical value in the ERCP management of pancreatic diseases.Pancreatic duct stones with chronic pancreatitis constituted the primary indication for minor papilla cannulation.Patients with pancreas divisum achieved the highest technical success rate and pain relief rate following ERCP via the minor papilla.Post-ERCP pancreatitis is the main complication.