经内镜逆行胰胆管造影相关穿孔临床分析

Clinical Analysis of Perforation Associated with Endoscopic Retrograde Cholangiopancreatography

目的分析经内镜逆行胰胆管造影(ERCP)术中及术后并发消化道或胆道穿孔的原因、诊疗方法以及如何预防此类并发症。方法收集2018年1月至2020年10月于郑州大学第一附属医院行ERCP诊疗术术中及术后并发穿孔的病例的临床资料,回顾性分析ERCP诊疗术并发穿孔的部位、原因及诊疗手段,以及如何预防穿孔。结果共收集到2968例接受ERCP术治疗的患者的临床资料,其中发生穿孔6例,发生率为0.2%,包括胆道穿孔2例和十二指肠壁穿孔4例。按照穿孔原因分类,6例患者中包括操作十二指肠镜导致穿孔4例,导丝或取石网篮导致穿孔1例,球囊扩张导管导致穿孔1例。这6例发生穿孔的患者均接受保守治疗并顺利出院,无接受手术治疗的病例。结论实施ERCP诊疗术并发穿孔时,需要根据穿孔的部位、原因、发现时间以及患者的具体情况分析并及时处理。在进行ERCP诊疗术手术操作时,术者动作应规范、熟练,尤其需注意高龄及既往腹部尤其是上腹部有手术史的患者。操作过程中留意胆道造影情况及在内镜下检查十二指肠壁,常可及时发现穿孔。及时制定相应的个体化治疗方案有助于获得满意的预后。

Objective To analyse the causes,diagnosis and treatment of gastrointestinal or biliary perforation during and after endoscopic retrograde cholangiopancreatography(ERCP)and how to prevent such complications.Methods The clinical data of patients with perforation during and after ERCP in the First Affiliated Hospital of Zhengzhou University from January 2018 to October 2020 were collected.The location,causes,diagnosis and treatment of perforation in ERCP diagnosis and treatment were analyzed retrospectively,as well as how to prevent perforation.Results The clinical data of 2968 patients who received ERCP were collected,and perforation occurred in 6 cases,with an incidence of 0.2%,including 2 cases of bile duct perforation and 4 cases of duodenal wall perforation.According to the causes of perforation,there were 4 cases of perforation caused by duodenoscopy,1 case of perforation caused by guide wire or stone basket,and 1 case of perforation caused by balloon dilatation catheter.All the 6 cases were treated conservatively and discharged smoothly.No case received surgical treatment.Conclusion The diagnosis and treatment of ERCP complicated with perforation is analyzed and handled in time according to the location,cause,time of discovery and the specific conditions of the patients.When performing ERCP diagnosis and treatment,the operation should be standardized and skillful,especially for the elderly and patients with a history of abdominal surgery,especially the upper abdomen,which could reduce the incidence of perforation.During the operation,pay attention to cholangiography and endoscopic examination of the duodenal wall,which could often find perforation in time.Making the corresponding individualized treatment plan in time is helpful to obtain a satisfactory prognosis.