氩离子凝固术治疗消化道病变导致穿孔并发症13例分析

Analysis of 13 cases of perforations following argon plasma coagulation therapy of gastrointestinal diseases

目的分析氩离子凝固术(APC)治疗消化道病变导致穿孔并发症的临床特点和预后。方法回顾性分析2008年4月至2015年4月经河南省人民医院消化内镜中心行APC治疗消化道病变患者的临床资料。结果 7年时间内共有8 573例消化道病变患者接受APC治疗,13例发生消化道穿孔(0.15%,13/8 573),其中,胃底6例、食管2例、贲门1例、十二指肠球部1例、结肠3例,各部位之间的穿孔率无显著差异(P>0.05);除1例胃底穿孔患者无症状外,12例症状分别为:腹痛9例、腹胀4例、发热2例、2例食管穿孔、1例结肠穿孔患者出现颈部皮下气肿。46%(7/15)从事APC治疗的医生曾导致穿孔,不同医生之间的穿孔率无显著差异(P>0.05)。13例患者均在保守治疗后恢复。结论 APC是一项安全的内镜下治疗技术,但存在一定消化道穿孔的风险,胃底是最常见的穿孔部位,可行保守治疗。推荐在APC术后常规短期禁食水,密切观察患者症状和体征。

Objective To analyze the clinical features and prognosis of perforation following argon plasma coagulation therapy of gastrointestinal diseases. Method We retrospectively analyzed clinical data of patients with gastrointestinal diseases who were treated by APC in Digestive Endoscopy Center of Henan Province People＇s Hospital from Apr 2008 to Apr 2015. Results There were 8573 patients treated with APC for gastrointestinal diseases during 7-year period. Perforation occurred in 13 patients （0. 15%）, which included 6 cases in gastric fundus, 3 cases in colons, 2 cases in esophagus, 1 case in cardia, 1 case in duodenal ampulla. No statistically significant differences were found between different perforation sites （ P 〉 0.05 ）. 9 cases of abdominal pain, 4 cases of abdominal distention, 2 cases of fever had been recorded in these 13 patients except for one patient without any symptom. 3 cases of subcutaneous emphysema in neck had also been found in 2 patients with esophageal perforation and 1 patient with colon perforation. 46 percent of doctors （7/15） performing APC in our study experienced at least one perforation. There is no significant difference between doctors （ P 〉 0.05 ）. All these 13 patients recovered after conservative treatment. Conclusions APC is a safe procedure but it has a risk of perforation to some dagree. Gastric fund is the most common site of perforations. Patients with perforation could recover after conservative treatment. Postoperative fasting and water deprivation for a short time and close observation of patients＇ symptoms and sighs are recommended.