中国普外基础与临床杂志

中国普外基础与临床杂志

ERCP 相关胆胰十二指肠结合部穿孔 11 例诊治分析

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目的 探讨内镜下逆行胰胆管造影(ERCP)及相关操作并发胆胰十二指肠结合部穿孔的原因及诊治方法。 方法 回顾性分析成都军区总医院普通外科 2010 年 1 月至 2017 年 1 月期间收治的 11 例 ERCP 相关胆胰十二指肠结合部穿孔患者的临床病理资料。 结果 11 例 ERCP 相关胆胰十二指肠结合部穿孔患者中,<24 h 诊断 5 例,其中 4 例患者诊断后立即行手术治疗后治愈,1 例非手术治疗失败后予开腹手术治疗患者死亡;24~48 h 诊断 3 例,其中 2 例患者诊断后立即行手术治疗后治愈,1 例患者采用非手术治疗后死亡;>48 h 诊断 3 例,其中诊断后立即行手术治疗 2 例(治愈 1 例,死亡 1 例),非手术治疗 1 例患者死亡。胆管解剖病理状态:4 例为胆胰管合流异常,2 例为十二指肠乳头旁憩室,3 例为胆管胰腺段外露,2 例无明显解剖异常。 结论 ERCP 相关胆胰十二指肠结合部穿孔的病因较多,术前充分识别可能存在的胆管解剖病理状态可有效预测穿孔风险,早期准确诊断并立即采取外科手术干预是挽救患者生命的关键措施。

Objective To analyze cause and therapy of perforation of choledocho-pancreatico-duodenal junction associated with endoscopic retrograde cholangiopancreatography (ERCP) and its related procedures. Method The clinical data of 11 patients diagnosed with the perforation of choledocho-pancreatico-duodenal junction associated with the ERCP from January 2010 to January 2017 were analyzed retrospectively. Results Of 11 patients, 5 were diagnosed within 24 h, 3 were diagnosed between 24 h and 48 h, 3 were diagnosed above 48 h. Seven patients who immediately operated were cured following definitive diagnosis, 2 died after undergoing the delayed operation, 2 died after receiving the conservative treatment. The results of the anatomical-pathological factors showed that 4 were the anomalous arrangement of pancreaticobiliary ducts, 2 were the periampullary diverticula, 3 were the exposure of common bile duct in the pancreas level, 2 had no bile duct abnormality. Conclusions Preoperative evaluation on anatomical-pathological factor of bile duct is importance to effectively predict risk of perforation of choledocho-pancreatico-duodenal junction associated with ERCP. Early precise diagnosis and actively surgical operation are essential for optimal outcome in patient with perforation of choledocho-pancreatico-duodenal junction associated with ERCP.

关键词: 内镜下逆行胰胆管造影; 胆胰十二指肠结合部; 穿孔; 治疗

Key words: endoscopic retrograde cholangiopancreatography; choledocho-pancreatico-duodenal junction; perforation; treatment

引用本文: 朱永强, 汪涛, 程龙, 谭震, 余前军. ERCP 相关胆胰十二指肠结合部穿孔 11 例诊治分析. 中国普外基础与临床杂志, 2018, 25(11): 1332-1336. doi: 10.7507/1007-9424.201805095 复制

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