内镜逆行胰胆管造影并十二指肠穿孔9例分析附视频

被引：6

作者：

陈幼祥

吕农华

曾春艳

李国华

周小江

机构：

[1] 南昌大学第一附属医院消化科

来源：

中国内镜杂志 | 2013年 / 02期

关键词：

ERCP; 十二指肠穿孔; 治疗;

D O I：

暂无

中图分类号：

R816.5 [腹部及消化系];

学科分类号：

100106 [放射医学];

摘要：

目的探讨内镜逆行胰胆管造影(ERCP)并发十二指肠穿孔的原因、诊治方法。方法对9例ER-CP术后并发十二指肠穿孔患者的病因、操作方法、穿孔的诊断及治疗效果等行回顾性分析。结果该组2002年5月～2010年5月共行ERCP6233例,行治疗6134例(98.41%),其中胆管结石3567例,胆胰恶性肿瘤977例,其他1590例。乳头预切开或开窗术283例;胃大部切除(毕Ⅱ式术后)10例。并发十二指肠穿孔9例(0.144%),其中6例有腹部外科手术史;乳头预切开穿孔3例(1.060%);胃大部切除(毕Ⅱ式)内镜穿孔2例(20%);胆管结石ERCP术后穿孔8例(0.224%),胆胰肿瘤ERCP术后穿孔1例(0.102%)。9例患者8例术中出现右肾周积气,术后出现皮下气肿;1例出现腹腔积气。3例乳头预切开穿孔者行鼻胆管引流+胃肠减压和药物治疗痊愈;2例内镜穿孔经钛夹闭合穿孔+胃肠减压+药物治疗痊愈;1例进内镜穿孔、1例取石过程穿孔、2例毕Ⅱ式穿孔均行外科手术修补治疗痊愈。无死亡病例。结论毕Ⅱ式术后乳头预切开,有腹部手术史穿孔率较高;术中肾周积气对及时诊断穿孔有重要意义;根据穿孔情况可选择手术治疗或保守治疗。

引用

页码：170 / 173

页数：4

共 10 条

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