【摘要】 目的探讨经内镜逆行胰胆管造影(ERCP)并发消化道穿孔的原因、诊疗原则和预防。方法收集2009年1月至2013年12月上海市嘉定区中心医院施行ERCP术后并发穿孔病例,回顾分析穿孔原因、分型、诊疗经过。结果 4年间实施ERCP 459例,6例发生穿孔,发生率1.3%。依据穿孔原因,插镜导致穿孔3例,插入导管或乳头切开2例,导丝或网篮导致穿孔1例。保守治疗2例,均顺利出院;手术治疗4例,1例死亡。结论 ERCP相关穿孔依据穿孔原因、分型制订个体化治疗可获得较理想的预后。操作时精细、谨慎,特别对于高龄或有上腹部手术史者动作轻柔,可降低穿孔的发生率。更多还原

【Abstract】 Objective To evaluate the causes,diagnostic and therapeutic principles,and prevention of the perforation related to endoscopic retrograde cholangiopancreatography(ERCP). Methods All patients who developed perforation after ERCP in the Central Hospital of Shanghai Jiading District from January 2009 to December 2013 were recruited. The causes,types,and diagnosis and treatment of perforation were analyzed retrospectively. Results ERCP was done in 459 cases during the 4 years,and 6(1. 3%) of them developed perforation.The causes of perforation were as follows: endoscope insertion(3 cases),catheterization or sphincterotomy(2 cases),and guide wire or Dormia basket(1 case). Two cases received conservative management successfully and were discharged; four cases underwent surgical treatment,and one of them died. Conclusion Patients with ERCP-related perforation can achieve ideal prognosis through individualized treatment based on the causes and types of perforation. Careful and cautious operation,especially for the elderly or the patients with a history of upper abdominal operation,will reduce the incidence of ERCP-related perforation.更多还原