内镜下乳头肌切开术并发严重出血穿孔的外科治疗

Surgical management of severe hemorrhage andretroperitoneal perforation after endoscopic sphinc-terotomy

自１９９０年至１９９３年，作者共收治５例内镜下乳头肌切开术（ＥＳＴ）术后并发严重出血、穿孔患者。其中２例单纯出血和１例单纯穿孔患者存活，２例出血并穿孔患者死亡。通过对５例患者的治疗，作者认为早期诊断、早期手术是降低其死亡率的关键。对伴有结石残留、急性胰腺炎或胆管炎的患者，一旦诊断明确，即行手术。对不能行成形术的迟发性出血及穿孔时间较长的患者，手术设计要考虑隔绝和减少胆汁、胰液对ＥＳＴ切口的刺激，以免加重感染和诱发顽固性迟发性出血。

AbstractFrom 1990 to 1993, 5 patients with severe hemor-rhage and retroperitoneal perforaion following endo-scopic sphincterotomy(EST) were surgically treated.Two patients with hemorrhage and one with perfora-tion survived. The remaining two died of hemorrhageplus perforation. Early diagnosis and surgical interven-tion was very important to lower the mortality, espe-cially in those with common bile duct stones retention,acute pancreatitis, or cholangitis. For patients withlate stage perfOration or recurrent hemorrhage, pallia-tive procedure aimed at isolating the EST incision fromthe digestion of bile and pancreatic juice should be per-formed.