CAJ | 학술논문

目的结合穿孔Stapfer分型总结ERCP相关穿孔的诊治经验和教训.方法回顾10例ERCP并发消化道穿孔病例的临床资料,包括穿孔部位及原因、穿孔诊断及治疗方法、并发症和住院时间等,并依据Stapfer分型标准进行分型,归纳不同Stapfer分型消化道穿孔的诊治经验及教训.结果 Stapfer Ⅰ型穿孔3例(操作中内镜明确诊断),均行外科肠修补+胆道探查+T管引流术,平均住院36.0 d,有1例术后发生腹腔感染、肠瘘并发症；Ⅱ型穿孔6例(其中5例经CT明确诊断),l例予保守治疗成功,其他5例予外科手术治疗(2例行单纯修补手术,2例行修补+T管引流,1例行胃空肠转流术),平均住院50.6 d,有2例发生腹腔脓肿,1例发生肠瘘；Ⅲ型穿孔1例(经CT明确诊断),予保守治疗,住院时间10.0 d.全组患者均痊愈出院,无死亡病例.结论 CT检查是ERCP相关穿孔较为有效的诊断方法,穿孔类型以及诊治是否及时对预后和转归影响较大.
목적 결합천공Stapfer분형총결ERCP상관천공적진치경험화교훈.방법 회고10례ERCP병발소화도천공병례적림상자료,포괄천공부위급원인、천공진단급치료방법、병발증화주원시간등,병의거Stapfer분형표준진행분형,귀납불동Stapfer분형소화도천공적진치경험급교훈.결과 Stapfer Ⅰ형천공3례(조작중내경명학진단),균행외과장수보+담도탐사+T관인류술,평균주원36.0 d,유1례술후발생복강감염、장루병발증；Ⅱ형천공6례(기중5례경CT명학진단),l례여보수치료성공,기타5례여외과수술치료(2례행단순수보수술,2례행수보+T관인류,1례행위공장전류술),평균주원50.6 d,유2례발생복강농종,1례발생장루；Ⅲ형천공1례(경CT명학진단),여보수치료,주원시간10.0 d.전조환자균전유출원,무사망병례.결론 CT검사시ERCP상관천공교위유효적진단방법,천공류형이급진치시부급시대예후화전귀영향교대.
Objective To explore the therapeutic efficacy of ERCP-related perforation according to Stapfer type.Methods Data of 10 cases of ERCP-related perforation from January 2006 to July 2012 in our hospital were reviewed.These cases were categorized according to Stapfer classification.Differences in diagnosis,managements and clinical outcomes for different types of perforation were compared.Results There were 3 cases of type I perforation (discovered during ERCP),who were treated by suture of the perforation with T-drain.The mean hospitalization was 36 days.Inflammation occurred in 1 patient.There were 6 cases of type Ⅱ perforation (periVaterian),in which 5 were diagnosed by CT.One of these 6 patients was cured with conventional treatment,and 5 received surgery,including suture in 2,suture plus T-drain in 2 and duodenal diversion in 1.The mean hospitalization of type Ⅱ perforation was 50.6 days.There was 1 case of type Ⅲ perforation (bile duct),who was diagnosed by CT and cured conservatively,with 10.0 days of hospitalization.There was no death in these 10 patients.Conclusion CT is the best method to diagnose ER-CP-related perforation.The type of perforation and time of diagnosis can determine its management approach,surgery procedure and outcome.