内镜下乳头括约肌切开术术中、术后出血的诊治探讨  

Diagnosis and treatment of hemorrhage during and after the endoscopic sphincterotomy

作　　者：施云星[1] 王广勇[1] 吕礁[1] 周国中[1] 曾晓虹[1] 李玲霞[1] 过常琴 

机构地区：[1]解放军第四一一医院消化内科,上海200081

出　　处：《胃肠病学和肝病学杂志》2016年第8期937-940,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的探讨内镜下乳头括约肌切开术(endoscopic sphincterotomy,EST)术中、术后出血的原因和治疗方法。方法回顾性分析解放军第四一一医院EST术中、术后出血的12例患者临床治疗过程,总结其经验教训。结果 12例EST术中、术后出血患者中,即时出血9例,迟发性出血3例;渗血9例,搏动性出血3例;轻度出血9例,中度出血2例,重度出血1例。内镜下治疗成功10例(轻度出血9例,中度出血1例),内镜下止血无效行DSA治疗2例(中度出血1例,重度出血1例);并发轻度胰腺炎1例,无其他并发症;全部病例均治愈,无手术及死亡病例。结论 EST术中、术后出血多为渗血和即时出血,出血多为轻度至中度,内镜下治疗多能止血,无效时应及时行DSA或手术治疗。Objective To explore the etiological factors and treatment of hemorrhage during and after the endoscopic sphincterotomy（ EST）. Methods The etiology and treatment of 12 cases of hemorrhage during and after the EST from Mar. 2011 to Mar. 2016 were analyzed retrospectively. The experience was summarized. Results Among the 12 cases of hemorrhage during and after EST,there were 9 cases of immediate bleeding,3 cases of delayed bleeding; 9 cases of capillary hemorrhage,3 cases of permeating hemorrhage; 9 cases of mild hemorrhage,2 cases of moderate hemorrhage,1 case of severe hemorrhage. Ten patients were treated by successful endoscopic hemostasis（ mild hemorrhage in 9 cases,moderate hemorrhage in 1 case）. Two cases were offered angiographic embolization after failure endoscopic hemostasis. No other complications except 1 case occurred mild pancveatitis. All patients were cured without operation and death. Conclusion Hemorrhage during and after EST is capillary hemorrhage and immediate bleeding almost. Endoscopic hemostasis can stop the hemorrhage in most cases. DSA or surgical management is necessary for conservative treatment fail.

关 键 词：内镜下乳头括约肌切开术 并发症 出血 止血 

分 类 号：R57[医药卫生—消化系统]