ERCP罕见并发症--1例鼻胆管置入门静脉致大出血及处理  

Rare complication of ERCP--one case of hemorrhage caused by nasobiliary duct placement into portal vein and its management

作　　者：程晨[1] 李回香 刘丽娟[1] 张渝[1] CHENG Chen;LI Huixiang;LIU Lijuan;ZHANG Yu(Department of Gastroenterology,Hunan Provincial People′s Hospital,the First Affiliated Hospital of Hunan Normal University,Changsha 410005,China)

机构地区：[1][HT6K]湖南师范大学附属第一医院(湖南省人民医院)消化内科,湖南长沙410005

出　　处：《胃肠病学和肝病学杂志》2025年第3期465-468,共4页Chinese Journal of Gastroenterology and Hepatology

基　　金：湖南省卫健委科研计划项目(B2019056)。

摘　　要：经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)是将内镜插至十二指肠降部,并经十二乳头开口部或瘘口等部位插入相关器械,向胰胆管内注入造影剂,对胰胆疾病进行诊断及治疗。ERCP于1968年首次报道,随着技术的发展,已成为诊断和治疗胆胰疾病的重要手段。尽管ERCP技术逐渐成熟,但作为一种侵入性有创操作,不可避免出现相关并发症。ERCP并发症包括术后急性胰腺炎、胆道感染、出血、穿孔、镇静相关不良反应等。大多数ERCP术后出血是胃十二指肠及胆道腔内出血,在手术中很容易诊断,而ERCP术中门静脉显影及鼻胆管置入极为罕见。既往国内外文献相关并发症极少报道,且主要发生在胰腺疾病的患者中,尚无肝硬化患者门静脉延迟性大出血的报道。本文报道我院1例ERCP术中误置引流管于门静脉致门静脉延迟性大出血的肝硬化患者内外科联合诊疗过程。Endoscopic retrograde cholangiopancreatography(ERCP)is the diagnosis and treatment of pancreaticobiliary diseases by inserting the endoscope into the descending duodenum,and inserting relevant instruments through the opening of the duopapillae or fistula.ERCP was first reported in 1968 and has become an important means of diagnosing and treating biliary and pancreatic diseases with the development of technology.Although ERCP technology is gradually maturing,as an invasive procedure,related complications are inevitable.Complications of ERCP include postoperative acute pancreatitis,biliary tract infection,hemorrhage,perforation and sedation-related adverse reactions.Most postoperative ERCP bleeding is gastroduodenal and biliary intraluminal bleeding that is easily diagnosed during surgery,while portal vein imaging and nasobiliary placement during ERCP are extremely rare.In the past,complications were rarely reported in the literature at home and abroad,and mainly occurred in patients with pancreatic diseases,and delayed massive hemorrhage in the portal vein in patients with liver cirrhosis has not been reported.This article reported on the combined medical and surgical diagnosis and treatment process of a patient with liver cirrhosis who was mistakenly placed in the portal vein due to the incorrect placement of a drainage tube in the portal vein in our hospital during ERCP.

关 键 词：经内镜逆行胰胆管造影术 门静脉出血 术后并发症 全覆膜金属支架 

分 类 号：R575.7[医药卫生—消化系统]