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与ERCP相关的穿孔的管理:一项大型多中心研究
Tomoya Emori1, Tomoaki Yamasaki2, Masahiro Itonaga3
1Department of Gastroenterology, Wakayama Rosai Hospital, Wakayama, Japan.
Gastrointestinal endoscopy
|December 17, 2024
概括
随着内镜逆行性胆血管细胞造影 (ERCP) 相关的十二指甲孔是罕见的,但严重的. 与手术相比,早期内镜诊断和治疗显著减少住院时间,并改善结果.
科学领域:
- 胃肠病学和内镜检查
- 手术不良事件 手术不良事件
- 医疗器械并发症 医疗器械并发症
背景情况:
- 穿孔是一个罕见但严重的并发症,内镜逆行胆板细胞造影 (ERCP).
- 对于与ERCP相关的十二指肠穿孔的最佳管理 (手术或内镜) 缺乏共识.
- 本研究研究了基于损伤机制的十二指甲孔穿孔的特征和结果.
研究的目的:
- 评估与ERCP相关的十二指甲孔穿孔的发生率和结果.
- 根据损伤机制,诊断时间和治疗方式来比较临床结果.
- 确定ERCP诱导的十二指甲孔的最佳管理策略.
主要方法:
- 在日本21家三级医院接受ERCP的51,957名患者的回顾性分析 (2017年4月至2022年3月).
- 使用Stapfer系统对十二指甲孔穿孔的分类.
- 对严重不良事件,停留时间 (LOS) 和死亡率的评估.
主要成果:
- 58名 (0.12%) 患者经历了与ERCP相关的十二指甲孔.
- 平均LOS为27.1天,死亡率为2%.
- 与手术治疗相比,内镜治疗与显著缩短的LOS和愈合时间有关. 程序内诊断也与更好的结果有关.
结论:
- 在ERCP期间对穿孔的程序内诊断对于预防严重不良事件至关重要.
- 建议仔细审查光镜和内镜成像.
- 对于在手术过程中被诊断出与ERCP相关的十二指甲孔穿孔的患者,应优先考虑内镜治疗.
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