内镜逆行胰胆管造影术 (ERCP) 穿孔的保守和手术治疗的早期结果：单中心经验。

Early results of conservative and surgical approach in Endoscopic Retrograde Cholangiopancreatography (ERCP) Perforations Single center experience.

出版信息

Ann Ital Chir. 2023;94:367-374.

Abstract

INTRODUCTION

Endoscopic retrograde cholangiopancreatography (ERCP) ± endoscopic sphincterotomy, and after perforation (ERCP-P), which is a common method used for the diagnosis in the past and treatment today in hepatopancreatobiliary cases, is a rare complication with high mortality. While surgery has been at the forefront in perforations after ERCP in previous years, conservative treatment is widely accepted today, except for some special conditions. The aim of this study was to determine the incidence of ERCP-P in a hepatobiliary center, the outcome of the treatment modalities applied, and the risk factors for mortality due to perforations.

MATERIALS AND METHODS

Patients hospitalized in our clinic with the diagnosis of ERCP-P were retrospectively analyzed. Age, gender, ERCP indication, method of treatment applied, time between ERCP-P diagnosis and treatment, injury class, length of stay (LOS) and early results of the patients were examined.

RESULTS

45 patients were hospitalized in our clinic upon the development of ERCP-P between the years of 2006 and 2022. 37 of these patients underwent conservative and 8 patients underwent surgical treatment. When the perforation types were examined, Stapfer Type 1 was found in 4 patients, Type II in 6 patients, Type III in 3 patients and Type IV ERCP-P in 32 patients (71.1%). LOS was longer in the surgical group than in the conservative treatment group (p=0.040). Mortality was observed in 15.56% of patients. 57.1% of these patients were in the surgical group. In the multivariate analysis, the time between diagnosis and treatment of ERCP-P, which is the only factor affecting mortality, was found. The risk of death was found to be 30.61 times higher in patients with a time elapsed between ERCP-P diagnosis and treatment exceeding 24 hours compared to patients with a time elapsed ≤24 hours (p=0.030).

DISCUSSION

In our study, it was observed that the prognosis of the patients in the surgical group was poor and the length of stay was significantly longer. At the same time, the only effective factor on mortality is the time between ERCPP diagnosis and treatment.

KEY WORDS

Endoscopic Retrograde Cholangiography, Perforation, R Factors.

摘要

简介

内镜逆行胰胆管造影术（ERCP）±内镜下括约肌切开术，以及穿孔后（ERCP-P），过去是肝胆胰病例的常用诊断和治疗方法，是一种罕见但死亡率很高的并发症。虽然手术在过去几年中一直是 ERCP 后穿孔的首选治疗方法，但如今除了一些特殊情况外，保守治疗也被广泛接受。本研究旨在确定肝胆中心 ERCP-P 的发生率、应用的治疗方式的结果以及穿孔导致死亡的危险因素。

材料和方法

对我院因 ERCP-P 住院的患者进行回顾性分析。检查了年龄、性别、ERCP 指征、应用的治疗方法、ERCP-P 诊断与治疗之间的时间、损伤分级、住院时间（LOS）和患者的早期结果。

结果

2006 年至 2022 年期间，我院共有 45 例患者因 ERCP-P 住院。其中 37 例患者接受保守治疗，8 例患者接受手术治疗。检查穿孔类型时，发现 Stapfer Ⅰ型 4 例，Ⅱ型 6 例，Ⅲ型 3 例，Ⅳ型 ERCP-P 32 例（71.1%）。手术组的 LOS 长于保守治疗组（p=0.040）。观察到 15.56%的患者死亡。其中 57.1%的患者在手术组。多因素分析发现，ERCP-P 诊断与治疗之间的时间是唯一影响死亡率的因素。与 ERCP-P 诊断与治疗时间≤24 小时的患者相比，ERCP-P 诊断与治疗时间超过 24 小时的患者死亡风险高 30.61 倍（p=0.030）。