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首页> 外文期刊>Surgical Endoscopy >Clinical outcomes of patients who experienced perforation associated with endoscopic retrograde cholangiopancreatography
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Clinical outcomes of patients who experienced perforation associated with endoscopic retrograde cholangiopancreatography

机译：内镜逆行胰胆管造影穿孔的患者的临床结局

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Background: Perforation after endoscopic retrograde cholangiopancreatography (ERCP) is a rare but severe complication. The purpose of this study was to assess the clinical outcomes with perforations after ERCP from a large number of cases. Methods: Among 11,048 patients who underwent ERCP during 10 years, medical records from 68 patients (0.62 %) who experienced post-ERCP perforation with radiologic, endoscopic, or surgical evidence were retrospectively reviewed. We assessed the clinical outcomes of patients and analyzed the factors associated with poor outcomes, which were defined as mortality, prolonged hospital stay due to complications, or loss of chance of cure in the case of cancer. Results: Twenty-nine patients were male, and the median age was 65.0 years. Therapeutic ERCP was performed in 52 cases (77 %). Common mechanisms of perforation were endoscopic sphincterotomy (37 %), catheter or guidewire (34 %), and endoscope (19 %). In contrast to 9 patients who underwent emergent operation, 59 patients (87 %) were conservatively treated. In 44 patients, perforation was detected during the procedure; however, detection after 24 h or permitted oral intake before detection occurred in 18 cases (27 %). Although 58 patients recovered without poor outcomes, 10 patients (15 %) experienced poor outcomes, which consisted of mortality (n = 4), loss of chance of cure (n = 2), and prolonged hospital stay without surgery more than 1 month due to complications (n = 4). By multiple logistic regression analysis, perforation by endoscope and rebound tenderness was statistically associated with poor outcomes (odds ratio: 13.7 and 7.3, respectively). Conclusions: Most patients fully recovered from perforation; however, some patients experienced grave outcomes, including mortality. Perforation by endoscope and rebound tenderness was significantly associated with poor outcomes.
机译：背景：内镜逆行胰胆管造影（ERCP）后的穿孔是一种罕见但严重的并发症。这项研究的目的是从大量病例中评估ERCP术后穿孔的临床结果。方法：回顾性回顾了10048名接受ERCP的10年患者，其中68例（0.62％）经历了ERCP穿孔后有放射学，内镜或手术证据的患者的病历。我们评估了患者的临床结局并分析了与不良结局相关的因素，这些因素被定义为死亡率，因并发症导致的住院时间延长或癌症患者治愈的机会减少。结果：29例患者为男性，中位年龄为65.0岁。 ERCP治疗进行了52例（77％）。穿孔的常见机制是内窥镜括约肌切开术（37％），导管或导丝（34％）和内窥镜（19％）。与9例接受急诊手术的患者相比，保守治疗了59例患者（87％）。在44名患者中，在手术过程中发现了穿孔;但是，有18例（27％）在24小时后检出或在检出前允许口服摄入。尽管有58例患者康复但预后不佳，但10例患者（15％）的预后较差，包括死亡率（n = 4），治愈机会丧失（n = 2）以及因不手术而长期住院超过1个月并发症（n = 4）。通过多重逻辑回归分析，内窥镜穿孔和反弹压痛与不良预后在统计学上相关（比值分别为13.7和7.3）。结论：大多数患者可从穿孔中完全康复。但是，有些患者经历了严重的预后，包括死亡率。内窥镜穿孔和反弹压痛与不良预后显着相关。

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