ERCP罕见并发症——门静脉显影并误置引流管

Rare complication during ERCP: portal vein cannulation and biliary stent in portal vein

目的：分析内镜逆行胰胆管造影（endoscopic retrograde cholangiopancreatography,ERCP）极罕见并发症——门静脉插管显影的发生机制及防治。方法：报道1例ERCP术中极罕见并发症——门静脉显影并误置引流管的临床诊治,检索并分析2005年至2015年国内外文献报道的ERCP术中4例门静脉显影病例。国内外尚未见ERCP术中门静脉误置引流管的并发症报道。结果：5例门静脉显影病例中,除1例胆管门静脉瘘外,其余4例为导管及导丝误插入门静脉。2例术中即拔除导管及导丝。1例鼻胆管误置入门静脉,经皮经肝穿刺置管引流减黄3 d后拔除。1例系晚期肿瘤梗阻性黄疸病例,胆道造影时即发现胆管门静脉瘘,胆总管内留置塑料支架减黄,2个月后死于原发病。另外4例均在观察1~7 d后作后续处理。ERCP取石1例。ERCP扩张狭窄胆管1例。本例行开腹手术治疗原发疾病,同时去除塑料支架。结论：门静脉显影并误置管引流是ERCP极其罕见的并发症。对于ERCP应提高警惕,仔细操作,正确判断。根据不同病情妥善处理,必要时立即手术治疗。

Objective To investigate the pathogenesis and intervention of portal vein cannulation during endoscopic retrograde cholangiopancreatography （ERCP）. Methods We present the clinical data of the case with an extremely rare complication during ERCP in which portal vein eannulation occurred combined with placement of a plastic endoscopic biliary stent in portal vein. A literature review was done and the data of this case combined with the other 4 cases reported between 2005 and 2015 were analyzed. To our knowledge, this is the first documented patient with stent in portal vein. Results Except the case with biliary portal vein fistula, catheter-induced and guidewire-induced portal vein cannulation occurred in other 4 cases. The catheter and guidewire were removed intra-operatively in 2 cases. Endoscopic nasobiliary drainage tube-induced portal vein cannulation occurred in 1 case and was removed after biliary drainage by PTCD 3 days. Plastic endoscopic biliary stent-induced portal vein cannulation occurred in 1 case. The case with advanced tumor and obstructive jaundice who was found biliary portal vein fistula during ERCP died 2 months later. The other 4 cases underwent secondary treatment after 1-7 d including 1 case with PTCD. One case was treated by ERCP gallstone removal and 1 case with bile duct stricture expanded by Balloon-associated ERCP. The case in this report was treated by open abdominal surgery and removing the plastic endoscopic biliary stent simultaneously. Conclusions Portal vein cannulation with or without endoscopic biliary stent is an extremely rare complication during ERCP. It is important to be awareness of this complication, careful operation, correct diagnosis and treatment based on different situations. Surgery should be performed timely if necessary.