背景:II型内镜逆行胰胆管造影术(ERCP)相关穿孔的治疗仍存在争议。本研究旨在比较覆膜自膨式金属支架(SEMS)的效果,手术,II型穿孔的保守治疗。
方法:从2010年1月至2021年12月,本研究收集了中国五家大型医院的相关数据。回顾性分析11年间行ERCP的26,673例患者的ERCP难度分级及ERCP相关穿孔情况。在55例II型穿孔患者中,41例患者植入胆道覆膜SEMS(支架组),10例接受手术(手术组),4例接受保守治疗(保守组)。
结果:在55例II型穿孔患者中,ERCP和计算机断层扫描对Ⅱ型穿孔的诊断率分别为10.91%(6/55)和89.09%(49/55),分别。5级ERCPⅡ型穿孔发生率(0.43%,11/2,537)明显高于1-3级ERCP(0.16%,32/19,471)。(P=0.004)和1-4级ERCP(0.26%,12/4,665)(P=0.008),分别。在手术组的10名患者中,仅对7例能够确定穿孔位置的患者进行了一期修复.支架组腹膜后脓肿发生率明显低于手术组(P=0.018)和保守组(P=0.001),分别。支架组的平均住院时间短于手术组(P=0.000)和保守组(P=0.001)。分别。
结论:II型穿孔的发生率取决于ERCP的难易程度。Ⅱ型穿孔采用覆膜SEMS治疗可明显降低腹膜后脓肿的发生率,缩短住院时间,比手术和保守治疗效果更好。
BACKGROUND: The management of type II endoscopic retrograde cholangiopancreatography (ERCP)-related perforation is still controversial. This study aimed to compare the effects of covered self-expandable metallic stent (SEMS), surgery, and conservative treatment for type II perforation.
METHODS: From January 2010 to December 2021, this study collected relevant data from five large hospitals in China. The data of ERCP difficulty grading and ERCP-related perforation in 26,673 cases that underwent ERCP during 11 years were retrospectively analyzed. Of 55 patients with type II perforation, 41 patients were implanted with a biliary covered SEMS (stent group), 10 underwent surgery (surgery group), and 4 received conservative treatment (conservative group).
RESULTS: Among the 55 patients with type II perforation, ERCP and computed tomography diagnostic rates of type II perforation were 10.91% (6/55) and 89.09% (49/55), respectively. The incidence of type II perforation in grade 5 ERCP (0.43%, 11/2,537) was significantly higher than that in grade 1-3 ERCP (0.16%, 32/19,471). (P = 0.004) and grade 1-4 ERCP (0.26%,12/4,665) (P = 0.008), respectively. Among the 10 patients in the surgical group, primary repair was performed in only 7 patients in whom location of the perforation could be identified. The incidence of retroperitoneal abscess was significantly lower in the stent group than in the surgery group (P = 0.018) and the conservative group (P = 0.001), respectively. The average hospital stay in the stent group was shorter than that in the surgery group (P = 0.000) and conservative group (P = 0.001), respectively.
CONCLUSIONS: The incidence of type II perforation was dependent on the degree of difficulty of ERCP. The treatment of type II perforation with a covered SEMS can significantly reduce the incidence of retroperitoneal abscess and shorten the hospital stay, with better results than surgical and conservative treatments.