内镜逆行胆板细胞造影 (ERCP) 相关的十二指甲孔穿孔:管理挑战和从一系列案例中吸取的经验教训
Duc N Nguyen1, Lai T Vo1, Hung V Vo1
1Liver Cancer Department, Binh Dan Hospital, Ho Chi Minh, VNM.
Cureus
|September 8, 2025
概括
在内镜逆行胆血管细胞造影 (ERCP) 后的十二指甲孔穿孔是罕见但严重的. 早期诊断和量身定制的管理,通常涉及手术,对于更好的患者结果至关重要.
科学领域:
- 胃肠病学 胃肠病学
- 手术并发症 手术并发症
- 医疗成像医学成像
背景情况:
- 十二指甲孔穿孔是一种罕见但严重的并发症,随着内镜逆行胆血管细胞造影 (ERCP).
- 及时诊断和有效管理至关重要,以尽量减少患者的发病率和死亡率.
研究的目的:
- 分析临床表现,诊断挑战和ERCP继发的十二指甲孔穿孔的管理策略.
- 根据穿孔的严重程度和患者的病情来评估保守与手术干预的有效性.
主要方法:
- 在ERCP后发展了十二指甲孔穿孔的四名患者的回顾性病例系列分析.
- 临床数据的审查,成像发现 (包括对比度增强CT),Stapfer分类和治疗结果.
- 评估并发症及其对管理和预后的影响.
主要成果:
- 四名患者 (36-56岁) 在ERCP治疗胆道阻塞后12-40小时内出现了十二指甲孔穿孔.
- 图像检查显示了穿孔的迹象,包括后或内空气.
- 三名患者最初接受了保守的治疗,其中两人需要推迟手术;一名患者接受了早期手术,一名非手术治疗的患者没有康复.
- 斯泰珀分类是1种类型在一个案例中,类型II在三个案例中.
结论:
- 与ERCP相关的十二指管穿孔具有显著的临床变异性和诊断挑战.
- 准确的Stapfer分类和及时的对比增强CT对于指导管理决策至关重要.
- 虽然保守治疗可能是有效的,但延迟识别或恶化往往需要手术干预.
- 多学科的方法,包括积极的排水和凝肠切口养,可以帮助治愈和改善结果.
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