经内镜逆行胰胆管造影所致十二指肠穿孔6例诊治分析

Diagnosis and therapy of ERCP-related duodenal perforation: an analysis of 6 cases

目的回顾性研究探讨经内镜逆行胰胆管造影(ERCP)所致十二指肠穿孔的预防、诊断和治疗。方法对2006年1月至2010年12月上海交通大学医学院附属仁济医院普外科6例ERCP相关十二指肠穿孔的临床资料进行分析,探讨合理的诊治方法。结果 6例穿孔病人中术前证实胆总管结石5例,胰头占位性病变致阻塞性黄疸1例。3例实施了十二指肠乳头括约肌切开术(EST),术后留置鼻胆管,2例插管失败,其中1例做了预切开后插管仍未成功;另1例为进镜过程中导致十二指肠憩室穿孔。2例保守观察治疗者均治愈;4例手术治疗,3例痊愈,1例死亡。结论术后严密观察、及时诊断并根据不同穿孔情况采取恰当的个体化治疗,可有效降低ERCP相关穿孔所造成的危险。

Objective To study the prevention, diagnosis and treatment of periduodenal perforation related to endoscopic retrograde cholangiopancreatography （ERCP） by retrospective research. Methods The clinical data of 6 cases of periduodenal perforation admitted from Janual7 2006 to December 2010 in Renji Hospital, Shanghai Jiaotong University School of Medicine were analyzed retrospectively. Results Of all the 6 cases, 5 cases were confirmed with bile duct stone, the other case had a mass on the head of the pancreas. Three cases received EST and nasol-biliary drainage after the procedure, in whom 2 cases were failed to cannulate and 1 case was failed for pre-spincterotomy was also failed. Another case developed periduodenal perforation directly by the duodenal scope. Two cases were treated conservatively. Four cases received open surgery, in whom 3 cases were fully-recovered and one died. Conclusion Postoperative careful observation, diagnosis on time and individual choice of reasonable treatment according to the different etiologies of perforation are the key factors to improve the results of periduodenal perforation related to ERCP.