壶腹周围内镜手术相关十二指肠及胰胆管穿孔的处理
Management of duodenal and pancreaticobiliary perforations associated with periampullary endoscopic procedures.
作者信息
Knudson Kelly, Raeburn Christopher D, McIntyre Robert C, Shah Raj J, Chen Yang K, Brown William R, Stiegmann Gregory
机构信息
Department of Surgery, University of Colorado, Denver Health Sciences Center, 12631 E 17th Avenue, C-313, PO Box 6511, Aurora, CO 80045, USA.
出版信息
Am J Surg. 2008 Dec;196(6):975-81; discussion 981-2. doi: 10.1016/j.amjsurg.2008.07.045.
BACKGROUND
The purpose of this study was to determine the incidence and outcome of pancreaticobiliary and duodenal (PB/D) perforations from periampullary endoscopic procedures and to examine whether clinical indexes are predictive of the need for operative management.
METHODS
A retrospective review compared patients who had operative intervention for PB/D perforation with those managed nonoperatively.
RESULTS
Thirty-two PB/D perforations occurred in 4,919 procedures (.6%). Twelve (37%) required operation; 20 (63%) were successfully managed nonoperatively. Radiographic imaging was not helpful in predicting the need for operation. A clinical scoring system was predictive of the need for operative management. The length of stay and morbidity rates were higher in the operatively managed patients.
CONCLUSIONS
Most endoscopic PB/D perforations can be successfully managed without operation and, clinical indices are most predictive in determining the need for surgery. Further prospective evaluation of this scoring system may help guide the need for and timing of operative intervention for PB/D perforations.
背景
本研究旨在确定壶腹周围内镜手术导致胰胆管和十二指肠（PB/D）穿孔的发生率及结局，并探讨临床指标是否可预测手术治疗的必要性。
方法
一项回顾性研究比较了因PB/D穿孔接受手术干预的患者与非手术治疗的患者。
结果
在4919例手术中发生了32例PB/D穿孔（0.6%）。12例（37%）需要手术治疗；20例（63%）通过非手术治疗成功治愈。影像学检查对预测手术需求并无帮助。一种临床评分系统可预测手术治疗的必要性。接受手术治疗的患者住院时间更长，发病率更高。
结论
大多数内镜下PB/D穿孔无需手术即可成功治愈，临床指标在确定手术需求方面最具预测性。对该评分系统进行进一步的前瞻性评估可能有助于指导PB/D穿孔手术干预的必要性和时机。
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