Booth F V, Doerr R J, Khalafi R S, Luchette F A, Flint L M
Department of Surgery, State University of New York, Buffalo General Hospital 14203-1154.
Am J Surg. 1990 Jan;159(1):132-5; discussion 135-6. doi: 10.1016/s0002-9610(05)80618-x.
We reviewed 574 endoscopic sphincterotomy procedures. Fifty-six precut papillotomies were performed. Presenting conditions included choledocholithiasis, cholangitis, benign and malignant papillary strictures, and stenosing papillitis. Complications were identified in 16 percent: perforation in 9 percent, pancreatitis in 5 percent, bleeding in 2 percent, and pancreatic abscess in 2 percent. One patient died. Six patients required operation for complications. Perforation of the duodenum or common bile duct seen within 8 hours was managed with drainage and closure of the perforation with minimal complications. Duodenal perforations operated on later than 8 hours required more extensive procedures. All these patients had significant post-operative complications. Three patients were managed nonoperatively. Precut papillotomy carries a significantly higher complication rate than conventional sphincterotomy. Our experience suggests that there is no place for conservative management of duodenal perforation.
我们回顾了574例内镜括约肌切开术。进行了56例预切开乳头切开术。临床表现包括胆总管结石、胆管炎、良性和恶性乳头狭窄以及狭窄性乳头炎。并发症发生率为16%：穿孔占9%，胰腺炎占5%，出血占2%，胰腺脓肿占2%。1例患者死亡。6例患者因并发症需要手术治疗。8小时内发现的十二指肠或胆总管穿孔通过引流和穿孔闭合处理，并发症最少。8小时后进行手术的十二指肠穿孔需要更广泛的手术。所有这些患者术后都有严重并发症。3例患者非手术治疗。预切开乳头切开术的并发症发生率明显高于传统括约肌切开术。我们的经验表明，十二指肠穿孔的保守治疗没有立足之地。
