经内镜逆行胰胆管造影相关穿孔诊治分析

Diagnosis and management of endoscopic retrograde cholangiopancreatography-related perforation

目的探讨经内镜逆行胰胆管造影术(ERCP)所致消化道穿孔的诊疗策略和经验教训。方法回顾性分析我院2005年3月至2015年12月收治的10例ERCP相关消化道穿孔病例的Stapfer分型、穿孔原因、并发症、治疗措施和术后住院时间,总结不同Stapfer分型消化道穿孔的诊治经验。结果 Stapfer I型穿孔2例,均行手术治疗预后较好。Stapfer II型穿孔7例,4例行保守治疗成功,平均术后住院时间19 d;3例ERCP后24 h之内行手术治疗,平均术后住院28 d。Stapfer III型穿孔1例,为胰管穿孔,放置胰管支架术后仍并发重症胰腺炎,术后18 d行胰腺炎清创术,病理确诊为胆囊癌,家属放弃治疗,于术后57 d死亡。结论CT检查有助于ERCP相关穿孔的早期诊断,依据患者的一般情况及穿孔的Stapfer分型制订个体化治疗可获得较为理想的预后。

Objective To investigate the strategy and experience in diagnosis and management of digestive tract perforation caused by endoscope retrograde cholangiopancreatography（ERCP）. Methods By retrospectively analyzing the Stapfer typing of perforated parts, cause of perforation, complications, therapeutic measures and the postoperative hospital stay of 10 cases with ERCP-related perforation in our hospital from Mar. 2005 to Dec. 2015, to summarize the experience on diagnosis and treatment of different types of ERCP-related perforation.Results There were 2 cases of Stapfer type I perforation which were successfully treated surgical operation.Among 7 patients with type II perforation, 4 of them were cured successfully by conservative treatment and mean postoperative hospital stay was 19 d, other 3 case of patients were operated within 24 h after ERCP and mean postoperative hospital stay was 28 d. One case of type III perforation was the pancreatic duct perforation, although the pancreatic stent was placed into pancreiatic duct, severe pancreatitis after operation was still occured.The debridement of pancreatitis was performed 18 d after the surgery and was pathologically diagnosed as gallbladder carcinoma. The patient died 57 d after surgery because of the patient＇s family gave up further treatment.Conclusion CT examination is helpful for the early diagnosis of ERCP-related perforation, as well formulating a persoanlized therapy according to the general situation and Stapfer typing of perforation, which can lead to a rather ideal prognosis.