经内镜逆行胰胆管造影相关穿孔6例临床分析

周海华; 苏进根; 陆奕宁; 王建平

doi:10.3969/j.issn.1001-5256.2014.12.016

经内镜逆行胰胆管造影相关穿孔6例临床分析

DOI: 10.3969/j.issn.1001-5256.2014.12.016

上海市嘉定区中心医院普外科

基金项目:

上海市医学重点专科建设资助(ZK2012A15)；

详细信息

中图分类号: R657.4
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- 被引次数: 0
出版历程
- 收稿日期: 2014-04-30
- 出版日期: 2014-12-20

Clinical analysis of risk factors for ERCP-related perforation

Department of General Surgery, Central Hospital of Shanghai Jiading District

Research funding:

摘要

摘要:
目的探讨经内镜逆行胰胆管造影(ERCP)并发消化道穿孔的原因、诊疗原则和预防。方法收集2009年1月至2013年12月上海市嘉定区中心医院施行ERCP术后并发穿孔病例,回顾分析穿孔原因、分型、诊疗经过。结果 4年间实施ERCP 459例,6例发生穿孔,发生率1.3%。依据穿孔原因,插镜导致穿孔3例,插入导管或乳头切开2例,导丝或网篮导致穿孔1例。保守治疗2例,均顺利出院;手术治疗4例,1例死亡。结论 ERCP相关穿孔依据穿孔原因、分型制订个体化治疗可获得较理想的预后。操作时精细、谨慎,特别对于高龄或有上腹部手术史者动作轻柔,可降低穿孔的发生率。
- 胰胆管造影术,内窥镜逆行 /
- 穿孔 /
- 因素分析,统计学
Abstract:
Objective To evaluate the causes, diagnostic and therapeutic principles, and prevention of the perforation related to endoscopic retrograde cholangiopancreatography (ERCP) . Methods All patients who developed perforation after ERCP in the Central Hospital of Shanghai Jiading District from January 2009 to December 2013 were recruited. The causes, types, and diagnosis and treatment of perforation were analyzed retrospectively. Results ERCP was done in 459 cases during the 4 years, and 6 (1. 3%) of them developed perforation.The causes of perforation were as follows: endoscope insertion (3 cases) , catheterization or sphincterotomy (2 cases) , and guide wire or Dormia basket (1 case) . Two cases received conservative management successfully and were discharged; four cases underwent surgical treatment, and one of them died. Conclusion Patients with ERCP-related perforation can achieve ideal prognosis through individualized treatment based on the causes and types of perforation. Careful and cautious operation, especially for the elderly or the patients with a history of upper abdominal operation, will reduce the incidence of ERCP-related perforation.
- cholangiopancreatography, endoscopic retrograde /
- perforation /
- factor analysis, statistical

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参考文献(15)

[1]FREEMAN ML, NELSON DB, SHERMAN S, et al.Complications of endoscopic biliary sphincterotomy[J].N Engl J Med, 1996, 335 (13) :909-918.

[2]LOPERFIDO S, ANGELINI G, BENEDETTI G, et al.Major early complications from diagnostic and therapeutic ERCP:a prospective multicenter study[J].Gastrointest Endosc, 1998, 48 (1) :1-10.

[3]COTTON PB, LEHMAN G, VENNES J, et al.Endoscopic sphincterotomy complications and their management:an attempt at consensus[J].Gastrointest Endosc, 1991, 37 (3) :383-393.

[4]MASCI E, TOTI G, MARIANI A, et al.Complications of diagnostic and therapeutic ERCP:a prospective multicenter study[J].Am J Gastroenterol, 2001, 96 (2) :417-423.

[5]HOWARD TJ, TAN T, LEHMAN GA, et al.Classification and management of perforations complicating endoscopic sphincterotomy[J].Surgery, 1999, 126 (4) :658-663.

[6]STAPFER M, SELBY RR, STAIN SC, et al.Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy[J].Ann Surg, 2000, 232 (1) :191-198.

[7]ENNS R, ELOUBEIDI MA, MERGENER K, et al.ERCP-related perforations:risk factors and management[J].Endoscopy, 2002, 34 (4) :293-298.

[8]BOOTH FV, DOERR RJ, KHALAFI RS, et al.Surgical management of complications of endoscopic sphincterotomy with precut papillotomy[J].Am J Surg, 1990, 159 (1) :132-135.

[9]BYUNG SK, IN-GYU K, BYOUNG YR, et al.Management of endoscopic retrograde cholangiopancreatography-related perforations[J].J Korean Surg Soc, 2011, 81 (3) :195-204.

[10]KAYHAN B, AKDOGˇAN M, SAHIN B.ERCP subsequent to retroperitoneal perforation caused by endoscopic sphincterotomy[J].Gastrointest Endosc, 2004, 60 (5) :833-835.

[11]SEIBERT DG.Use of an endoscopic clipping device to repair a duodenal perforation[J].Endoscopy, 2003, 35 (5) :189.

[12]MUTIGNANI M, IACOPINI F, DOKAS S, et al.Successful endoscopic closure of a lateral duodenal perforation at ERCP with fibrin glue[J].Gastrointest Endosc, 2006, 63 (4) :725-727.

[13]CHUNG RS, SIVAK MV, FERGUSON DR.Surgical decisions in the management of duodenal perforation complicating endoscopic sphincterotomy[J].Am J Surg, 1993, 165 (6) :700-703.

[14]SARLI L, PORRINI C, COSTI R, et al.Operative treatment of periampullary retroperitoneal perforation complicating endoscopic sphincterotomy[J].Surgery, 2007, 142 (1) :26-32.

[15]AVGERINOS DV, LLAGUNA OH, LO AY, et al.Management of endoscopic retrograde cholangiopancreatography:related duodenal perforations[J].Surg Endosc, 2009, 23 (4) :833-838.

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