内窥镜括约肌切开并发十二指肠穿孔24例分析

Cause of the duodenal perforation due to endoscopic sphincterotomy： an analysis of 24 cases

目的分析内窥镜括约肌切开后并发十二指肠穿孔24例的病因以及探讨预防这种并发症的方法。方法回顾分析近4年作者所在地区5家医院因胆道疾病施行EST治疗致十二指肠穿孔24例。结果保守治疗成功7例，手术治疗存活6例，死亡11例，死亡率达45．83％。结论内窥镜括约肌切开术后并发十二指肠穿孔的发生率〈1％，这种并发症一旦发生，死亡率甚高（该组为45．83％），咎其原因为EST手术指征掌握不当，操作人员训练不够等，应高度注意预防这种并发症的发生。

Objective To analyze the cause of the duodenal perforation due to endoscopic sphincterotomy （EST） and explore the methods to prevent this condition. Methods A total of 24 patients with bile duct disease underwent EST and complicated duodenal perforation at our hospital and other 4 hospitals in last 4 years were retrospectively reviewed. Result Thirteen patients were treated by medicine and 6 of them died. For the 11 patients treated by operation, 5 of them died. The total mortality was 45.83 % . Conclusion The incidence of duodenal perforation is 〈 1 % after the endoscopic sphincterotomy. In case of such complications, the mortality is high. Improper operation indication of EST, inadequate training of operators etc. are the reasons for it. More attention should be paid to the prevention of such complications.