Boender J, Nix G A, de Ridder M A, van Blankenstein M, Schütte H E, Dees J, Wilson J H
Department of Diagnostic Radiology, University Hospital, Rotterdam-Dijkzigt, The Netherlands.
Endoscopy. 1994 Feb;26(2):209-16. doi: 10.1055/s-2007-1008945.
In a prospective study, the complications observed in 242 consecutive patients after endoscopic sphincterotomy for common bile duct stones were recorded over a period of up to three months. Patients with previous gastric surgery, papillotomy, or additional pancreato-biliary disease other than gallbladder stones were excluded. The overall complication rate was 14%, 74% of these complications being moderate or severe. The complication rate due to cholangitis was higher in (1) the group with retained stones following complete papillotomy and without biliary drainage, and (2) the group with failed precut papillotomy and drainage after cholangiography, both compared to patients with successful drainage (75% vs. 2.6%: p < 0.001 and 40% vs. 2.6%: p = 0.001 respectively). Both pancreatitis and retroperitoneal air leakage occurred in 1.7% of cases. They were more frequently observed in patients with a smaller diameter (< 10 mm) in the distal common bile duct (5.6% vs. 0%: p = 0.007 for pancreatitis, and 2.8% vs. 1.2%; n.s. for perforation) and especially following precut papillotomy (13.0% for pancreatitis and 8.7% for perforation), which had to be performed more often in these patients. Bleeding following sphincterotomy was relatively frequent when the papilla was located at the lower rim of or inside a diverticulum, compared to patients without a diverticulum (16.2% vs. 2.7%: p = 0.004 and 26.7% vs. 2.7%: p < 0.001 respectively). When the papilla was located inside diverticula, both the rate of perforation and bleeding increased following precut papillotomy, compared with standard papillotomy only (33% vs. 0%, n.s., and 33% vs. 22%, n.s.).(ABSTRACT TRUNCATED AT 250 WORDS)
在一项前瞻性研究中,对242例因胆总管结石接受内镜括约肌切开术的连续患者在长达三个月的时间内观察到的并发症进行了记录。排除既往有胃手术、乳头切开术或除胆囊结石外的其他胰腺胆管疾病的患者。总体并发症发生率为14%,其中74%的并发症为中度或重度。与引流成功的患者相比,(1)完全乳头切开术后结石残留且无胆道引流的组,以及(2)胆管造影后预切开乳头切开术和引流失败的组,胆管炎导致的并发症发生率更高(分别为75%对2.6%:p<0.001和40%对2.6%:p = 0.001)。胰腺炎和腹膜后气体泄漏的发生率均为1.7%。在胆总管远端直径较小(<10 mm)的患者中更常观察到(胰腺炎为5.6%对0%:p = 0.007,穿孔为2.8%对1.2%;无显著性差异),尤其是在预切开乳头切开术后(胰腺炎为13.0%,穿孔为8.7%),而这些患者中必须更频繁地进行预切开乳头切开术。与无憩室的患者相比,当乳头位于憩室下缘或憩室内时,括约肌切开术后出血相对频繁(分别为16.2%对2.7%:p = 0.004和26.7%对2.7%:p<0.001)。当乳头位于憩室内时,与仅行标准乳头切开术相比,预切开乳头切开术后穿孔和出血的发生率均增加(分别为33%对0%,无显著性差异,33%对22%,无显著性差异)。(摘要截断于250字)