Types and management of perforations occurring during endoscopic retrograde cholangiopancreatography
Types and management of perforations occurring during endoscopic retrograde cholangiopancreatography
复制标题
DOI：
10.1556/oh.2014.29829
复制
发表时间：
2014-02-01
期刊：
影响因子：
0.6
通讯作者：
Gasztonyi Beata
中科院分区：
文献类型：
--
作者：
Voelgyi Zoltan;Szenes Maria;Gasztonyi Beata
作者讨论了与内镜逆行胰胆管造影相关的穿孔发生率，这在其他类型的并发症中相对罕见（0.3-1%）。根据穿孔的形式和位置，穿孔可分为三种类型。回顾文献后，作者得出结论，最常见的类型是壶腹周围穿孔，较不常见的是腹膜穿孔。前者通常经保守治疗后愈合，而后者则需要手术治疗。作者强调，如果存在报警体征（腹膜、脓毒症），及时诊断和手术治疗对预后有重要作用。还总结了已知的诱发因素，当手术需要更仔细的注意时（术后状态，针刀乳头切除术，壁内造影剂，长期检查）。在审查他们自己的病例后，作者确定他们自己中心的穿孔发生率为千分之四（10/2400），其中9例为壶腹周围型和1例腹膜型。6例需手术治疗，无死亡。作者得出结论，个体化治疗可以大大降低早期研究中报告的30-40%的死亡率。
The authors discuss the incidence of perforation related to endoscopic retrograde cholangio-pancreatography, which is relatively uncommon (0.3-1%) among other types of complications. Perforations can be classified into three types based on their forms and locations. Having reviewed the literature the authors conclude that the most common type is periampullary perforation and the less frequent one is peritoneal perforation. The former usually heals after conservative treatment, while the latter needs an operation. The authors emphasize the important prognostic role of timely diagnosis and surgical treatment if alarming signs (peritoneal, septic) are present. Known predisposing factors, when the procedure needs more careful attention, are also summarized (postoperative status, needle knife papillectomy, intramural contrast media, long lasting examination). After reviewing their own cases, the authors establish that the incidence of perforation in their own centre was four per thousand (10/2400), out of which nine were periampullar and one peritoneal type. In 6 cases operation was necessary, and there was no mortality. The authors conclude that individually tailored therapy can largely reduce the 30-40% mortality rate reported in earlier studies.