Mellinger J D, Ponsky J L
Department of Surgery, Mt. Sinai Medical Center, Cleveland, Ohio 44106.
Surg Gynecol Obstet. 1991 Jun;172(6):465-9.
Hemorrhage is the most frequent complication of endoscopic sphincterotomy, with a reported incidence of 2 to 9 per cent. Previous reports have generally defined this complication clinically, leaving the issue of occult bleeding after sphincterotomy essentially unaddressed. Seventy-five serial sphincterotomies were reviewed to further assess this complication. Nine patients had clinically evident hemorrhage and 27 patients had occult bleeding manifested only by a decrement in hematologic parameters, for a total postsphincterotomy bleeding rate of 48 per cent. No statistically significant risk factors for bleeding were delineated. Endoscopically recognized bleeding at the time of the sphincterotomy was 47 per cent sensitive and 85 per cent specific in predicting postprocedural bleeding. Significant delayed hemorrhage was manifest in three patients, one of whom had clinically occult bleeding. We conclude that bleeding complicates endoscopic sphincterotomy much more frequently than previously reported, although often in a clinically occult manner. Significant delayed bleeding can occur, and may not be clinically apparent. Bleeding recognized endoscopically at the time of sphincterotomy is an insensitive but relatively specific predictor of postprocedural bleeding. As use of endoscopic sphincterotomy increases, careful surveillance for hemorrhagic complications, as well as efforts to identify factors predisposing to the same, will be of increasing importance.
出血是内镜下括约肌切开术最常见的并发症，报道的发生率为2%至9%。以往的报告通常从临床角度定义这一并发症，括约肌切开术后隐匿性出血的问题基本上未得到解决。我们回顾了75例连续的括约肌切开术，以进一步评估这一并发症。9例患者出现临床明显出血，27例患者仅表现为血液学参数下降的隐匿性出血，括约肌切开术后总出血率为48%。未发现有统计学意义的出血危险因素。括约肌切开术时内镜识别出的出血在预测术后出血方面，敏感度为47%，特异度为85%。3例患者出现明显的延迟性出血，其中1例有临床隐匿性出血。我们得出结论，尽管出血通常以临床隐匿的方式出现，但内镜下括约肌切开术出血的并发症比之前报道的更为常见。可能会发生明显的延迟性出血，且可能在临床上不明显。括约肌切开术时内镜识别出的出血是术后出血的一个不敏感但相对特异的预测指标。随着内镜下括约肌切开术的应用增加，仔细监测出血并发症以及努力识别易患因素将变得越来越重要。
