Objective To investigate the clinical applicative of short 5 Fr pancreatic duct (PD) stents in difficult biliary cannulation of ERCP. Methods 131 patients who underwent difficult biliary cannulation during routine ERCP were randomized to receive prophylactic short 5 Fr PD stents (stent group, 66 patients) and not (control group, 65 patients) from January 2012 to October 2015. The success rate of biliary cannulation for the first ERCP, scores of abdominal pain, the incidence of post-ERCP pancreatitis (PEP) and hyperamylasemia and severe post-ERCP pancreatitis were analyzed. Results The success rate of biliary cannulation for the first ERCP was significantly higher with the stent group than the control group. The scores of abdominal pain of the stent group was significantly lower than the control group. The postoperative serum amylase value at 3 h and 24 h were obviously lower in PD stents group than those in control group. The incidence of hyperamylasemia, post-ERCP pancreatitis, severe post-ERCP pancreatitis were also significantly lower with PD stents group than the control group. 3 cm long 5 Fr PD stents has high success rate of placement, high spontaneous migration rate, low complications, decreases the need for endoscopic removal. Conclusion In difficult biliary cannulation during ERCP, placement of short 5 Fr PD stent is safe and effective, enhance the success rate of biliary cannulation, relieve the abdominal pain, reduces the rate of post-ERCP pancreatitis efficiently.%目的：探讨经内镜逆行胰胆管造影术（ERCP）在困难胆管插管病例中置入3 cm 长5Fr 胰管支架的临床应用价值。方法回顾性分析2012年1月-2015年10月在该科住院需行 ERCP 治疗的困难胆管插管131例患者的临床资料，根据术中是否预防性放置短5Fr 胰管支架，将其随机分为胰管支架组66例和对照组65例。比较两组术后首次 ERCP 胆管插管成功率、术后腹痛情况、高淀粉酶血症、ERCP 术后胰腺炎（PEP）及重症胰腺炎发生率。结果在胰管支架组中首次 ERCP 胆管插管成功率明显高于对照组；术后腹痛评分较对照组低；术后3 h 和术后24 h 血淀粉酶值均低于对照组；术后高淀粉酶血症、急性胰腺炎和重症胰腺炎发生率均低于对照组，差异均有统计学意义。采用3 cm 长5Fr 胰管支架置管成功率高，自发脱落率很高、并发症少，减少再次行内镜取出支架的概率。结论短5Fr 胰管支架留置在内镜困难胆管插管中的运用是安全、有效的，既能提高胆管插管成功率、减轻患者术后腹痛程度，又能有效地降低 PEP 的发生率和严重程度。
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