内镜下逆行胰胆管造影术后并发十二指肠穿孔14例分析

Management of duodenal perforation after endoscopic retrograde cholangiopancreatography:clinical analysis of 14 cases

目的 探讨内镜下逆行胰胆管造影 (ERCP)术后并发十二指肠穿孔的诊治方法。方法 对 1996～2 0 0 3年ERCP术后并发十二指肠穿孔的 14例病人的诊治情况作回顾性分析。结果 8例行非手术治疗 ,其中 5例痊愈 ;3例中转手术治疗 ,2例痊愈 ,1例死亡。另 6例急诊手术 ,术式有穿孔修补、胆总管T管引流术、腹腔清创、腹腔引流、经胃窦十二指肠造瘘、空肠造瘘术 ,其中 5例痊愈 ,1例死亡。结论 ERCP术后并发十二指肠穿孔具有特征性的临床表现及放射影像学征象 ,可作为决定手术与非手术治疗选择的重要指标 ,治疗方式必须根据各病例的特点选择。

Objective To explore the appropriate diagnostic and therapeutic strategy for duodenal perforation after endoscopic retrograde cholangiopancreatography(ERCP). Methods A retrospective analysis was done in 14 cases of duodenal perforation related to ERCP hospitalized from 1996 to 2003. Charts were reviewed for the following parameters: Clinical presentation of perforation after ERCP, dignostic methods, time to diagnosis, radiographic extent and location of duodenal leak, method of management, length of stay and outcome. Results Eight patients were initially managed conservatively. Five of the 8 patients recovered;3 patients failed in nonsurgical management and required surgical management, among whom one died. Six patients received surgical management initially with one death.Conclusion Clinical and radiographic features of ERCP-related duodenal perforations can be used to stratify patients into surgical or nonsurgical management. A selective management scheme is proposed based on the individual features.