Ercan Metin, Bostanci Erdal Birol, Dalgic Tahsin, Karaman Kerem, Ozogul Yusuf Bayram, Ozer Ilter, Ulas Murat, Parlak Erkan, Akoglu Musa
Department of Gastroenterological Surgery, Turkiye Yuksek Ihtisas Teaching and Research Hospital, Ankara, Turkey.
J Laparoendosc Adv Surg Tech A. 2012 May;22(4):371-7. doi: 10.1089/lap.2011.0392. Epub 2012 Jan 30.
The most important criterion in the management of endoscopic retrograde cholangiopancreatography (ERCP)-related perforations is the delineation of the injury pattern. The aim of the present study was to evaluate in a retrospective manner the patients who undergo surgery due to ERCP-related perforations.
Between January 2006 and December 2010, a total of 9209 ERCPs were performed at Turkiye Yuksek Ihtisas Teaching and Research Hospital, Ankara, Turkey. From these, perforation was diagnosed in 52 patients (0.56%). Twenty-four patients (46.2%) underwent surgery. Patients were evaluated according to age, gender, ERCP indication, comorbid disease, the time between diagnosis and perforation, the time between ERCP and surgical intervention, radiological and clinical signs, localization of the perforation, surgical procedure, hospitalization period, and postoperative outcome.
Twenty-four patients underwent surgery. Thirteen patients (54.1%) had lateral duodenal wall perforation, 4 patients (16.7%) had perforation in the afferent loop (these patients had Billroth-II gastroenterostomy at ERCP admission), 2 patients (8.3%) had bile duct perforation, and 1 patient (4.1%) had esophageal perforation. In 4 patients (16.7%), the localization of the perforation could not be found. Nine patients (37.5%) died in the postoperative period. Six patients had lateral duodenal wall perforation, 2 patients had afferent loop perforation, and one patient had esophagus perforation. Three patients died of nonsurgical reasons (myocardial infarction, serebrovascular occlusion, and cardiac dysrhythmia).
Duodenal wall perforations have a serious fatal outcome even if early surgical intervention is performed. In contrast to duodenal wall injuries, perivaterian and choledochal injuries have a better outcome.
内镜逆行胰胆管造影术（ERCP）相关穿孔处理中最重要的标准是明确损伤模式。本研究的目的是以回顾性方式评估因ERCP相关穿孔而接受手术的患者。
2006年1月至2010年12月期间，土耳其安卡拉的土耳其尤克谢克伊蒂萨斯教学与研究医院共进行了9209例ERCP。其中，52例（0.56%）被诊断为穿孔。24例（46.2%）患者接受了手术。根据年龄、性别、ERCP适应证、合并疾病、诊断与穿孔之间的时间、ERCP与手术干预之间的时间、放射学和临床体征、穿孔部位、手术方式、住院时间及术后结果对患者进行评估。
24例患者接受了手术。13例（54.1%）为十二指肠侧壁穿孔，4例（16.7%）为输入袢穿孔（这些患者在ERCP入院时行毕罗Ⅱ式胃肠吻合术），2例（8.3%）为胆管穿孔，1例（4.1%）为食管穿孔。4例（16.7%）患者的穿孔部位无法确定。9例（37.5%）患者术后死亡。6例为十二指肠侧壁穿孔，2例为输入袢穿孔，1例为食管穿孔。3例死于非手术原因（心肌梗死、脑血管闭塞和心律失常）。
即使早期进行手术干预，十二指肠壁穿孔仍有严重的致命后果。与十二指肠壁损伤不同，肝门周围和胆总管损伤的预后较好。
