经内镜逆行胰胆管造影术相关消化道穿孔的Stapfer分型及其诊疗

Stapfer classification and managements of ERCP-related gastrointestinal perforation

目的结合穿孔Stapfer分型总结ERCP相关穿孔的诊治经验和教训。方法回顾10例ERCP并发消化道穿孔病例的临床资料，包括穿孔部位及原因、穿孔诊断及治疗方法、并发症和住院时间等，并依据Stapfer分型标准进行分型，归纳不同Stapler分型消化道穿孔的诊治经验及教训。结果StapferI型穿孔3例（操作中内镜明确诊断），均行外科肠修补＋胆道探查＋T管引流术，平均住院36．0d，有1例术后发生腹腔感染、肠瘘并发症；Ⅱ型穿孔6例（其中5例经cT明确诊断），1例予保守治疗成功，其他5例予外科手术治疗（2例行单纯修补手术，2例行修补＋T管引流，1例行胃空肠转流术），平均住院50．6d，有2例发生腹腔脓肿，1例发生肠瘘；m型穿孔1例（经cT明确诊断），予保守治疗，住院时间10．0d。全组患者均痊愈出院，无死亡病例。结论CT检查是ERCP相关穿孔较为有效的诊断方法，穿孔类型以及诊治是否及时对预后和转归影响较大。

Objective To explore the therapeutic efficacy of ERCP-related perforation according to Stapfer type. Methods Data of 10 cases of ERCP-related perforation from January 2006 to July 2012 in our hospital were reviewed. These cases were categorized according to Stapler classification. Differences in diagnosis, managements and clinical outcomes for different types of perforation were compared. Results There were 3 cases of type I perforation （ discovered during ERCP）, who were treated by suture of the perforation with T-drain. The mean hospitalization was 36 days. Inflammation occurred in 1 patient. There were 6 cases of type II perforation （ periVaterian）, in which 5 were diagnosed by CT. One of these 6 patients was cured with conventional treatment, and 5 received surgery, including suture in 2, suture plus T-drain in 2 and duodenal diversion in 1. The mean hospitalization of type I1 perforation was 50. 6 days. There was 1 case of type III perforation （bile duct）, who was diagnosed by CT and cured conservatively, with 10. 0 days of hospitalization. There was no death in these 10 patients. Conclusion CT is the best method to diagnose ER- CP-related perforation. The type of perforation and time of diagnosis can determine its management ap- proach, surgery procedure and outcome.