Sarr M G, Fishman E K, Milligan F D, Siegelman S S, Cameron J L
Surgery. 1986 Sep;100(3):461-6.
The diagnosis, differentiation, and management of severe pancreaticoduodenal complications occurring after therapeutic endoscopic sphincterotomy and related procedures on the ampulla of Vater were reviewed for 254 patients. Five patients had duodenal (peri-Vaterian) perforation and six patients had clinically significant pancreatitis. Most patients were not suspected of having a significant complication the night of the procedure despite abdominal pain. Computer tomography proved to be the most accurate test for establishing the existence of a significant complication. A periduodenal collection of fluid (abscess) without significant pancreatic enlargement was the predominant complication in patients with duodenal perforation. In patients who had pancreatitis after peri-Vaterian procedures, generalized pancreatic enlargement and peripancreatic edema were most prominent. Four of the five patients with duodenal perforation required surgical drainage; all recovered. In contrast, four of the six patients with pancreatitis had medical therapy. One patient with pancreatitis died after multiple pancreatitic debridements were done. A second patient with pancreatitis who underwent exploration eventually recovered. Pancreaticoduodenal complications after therapeutic endoscopic sphincterotomy and related procedures are difficult to diagnose early; they should be suspected early and approached aggressively to limit morbidity and death.
对254例接受内镜下治疗性括约肌切开术及相关壶腹手术的患者，回顾了其发生的严重胰十二指肠并发症的诊断、鉴别及处理情况。5例患者发生十二指肠（壶腹周围）穿孔，6例患者出现具有临床意义的胰腺炎。尽管多数患者术后当晚有腹痛，但多数患者未被怀疑有严重并发症。计算机断层扫描被证明是确定是否存在严重并发症的最准确检查。十二指肠穿孔患者的主要并发症是十二指肠周围积液（脓肿），胰腺无明显肿大。壶腹周围手术后发生胰腺炎的患者，胰腺普遍肿大和胰腺周围水肿最为突出。5例十二指肠穿孔患者中有4例需要手术引流；均康复。相比之下，6例胰腺炎患者中有4例接受了内科治疗。1例胰腺炎患者在多次胰腺清创术后死亡。另1例接受探查的胰腺炎患者最终康复。内镜下治疗性括约肌切开术及相关手术后的胰十二指肠并发症早期难以诊断；应尽早怀疑并积极处理，以降低发病率和死亡率。
