经内镜逆行胰胆管造影所致十二指肠穿孔6例诊治分析

目的 回顾性研究探讨经内镜逆行胰胆管造影（ERCP）所致十二指肠穿孔的预防、诊断和治疗。 方法 对2006年1月至2010年12月上海交通大学医学院附属仁济医院普外科6例ERCP相关十二指肠穿孔的临床资料进行分析，探讨合理的诊治方法。 结果 6例穿孔病人中术前证实胆总管结石5例，胰头占位性病变致阻塞性黄疸1例。3例实施了十二指肠乳头括约肌切开术（EST），术后留置鼻胆管，2例插管失败，其中1例做了预切开后插管仍未成功；另1例为进镜过程中导致十二指肠憩室穿孔。2例保守观察治疗者均治愈；4例手术治疗，3例痊愈，1例死亡。 结论 术后严密观察、及时诊断并根据不同穿孔情况采取恰当的个体化治疗，可有效降低ERCP相关穿孔所造成的危险。

Diagnosis and therapy of ERCP-related duodenal perforation: an analysis of 6 cases

Objective To study the prevention, diagnosis and treatment of periduodenal perforation related to endoscopic retrograde cholangiopancreatography (ERCP) by retrospective research. Methods The clinical data of 6 cases of periduodenal perforation admitted from January 2006 to December 2010 in Renji Hospital, Shanghai Jiaotong University School of Medicine were analyzed retrospectively. Results Of all the 6 cases, 5 cases were confirmed with bile duct stone, the other case had a mass on the head of the pancreas...