内镜乳头括约肌切开术后出血的原因及外科处理

Massive bleeding after endoscopic sphinterotomy: cause and surgical managment

目的 探讨内镜下乳头括约肌切开（endoscopic sphincterotomy,EST）取石术后大出血的原因及外科处理方法。方法 Kocher切口游离十二指肠降部并纵行切开之,显露乳头创面出血点,检查出血原因,细丝线缝扎止血后缝闭十二指肠切口,行减压性胃造瘘。结果 在本组1030例EST患者中,术后出现出血398例,需外科手术处理的2例,均为细小动脉出血,其中1例为切开部位出现变异血管,1例为切开部位有误,均经手术止血后而治愈。结论 EST术后出现持续性出血多为动脉性出血,保守治疗无效者及时外科手术是必要的。

Objective To explore the cause and surgical management of mass bleeding after endoscopic sphincterotomy (EST). Methods In 1 080 patients who received endoscopic sphincterotomy in our hospital from June 1996 to June 2001, massive bleeding was complicated in 2 patients and needed to be treated by operation. During the operation, the duodenum was dissected laterally through Kocher incision and the papilla was exposed through a vertical incision of the descending duodenum. The bleeding vessels were suture-ligated, and gastrostomy was performed to prevent duodenum leakage. Results The massive bleeding was caused by incorrect incision in the papilla. The two patients recovered after operations. Conclusions Surgical management is necessary for EST-caused massive bleeding should conservative treatment fail.