| BackgroundERCP(endoscopic retrograde cholangiopancreatography)is an important endoscopic technique for the diagnosis and treatment of cholangiopancreatic duct diseases.It uses duodenoscopy to complete the diagnosis and treatment of cholangiopancreatic duct diseases with the aid of X-ray.In the past half a century,with the increasing maturity of this technology,it has been carried out in a wide range of hospitals.However,with the wide application of MRCP(magneticresonance cholangiopancreatography)in biliary tract,simple diagnostic ERCP has been rarely used in clinic because of its relative invasiveness.ERCP has become an important clinical method for the treatment of bile duct and pancreatic diseases.Compared with traditional surgery,ERCP has obvious advantages.Because of its advantages of less trauma,rapid recovery,low cost,and can be performed many times in a short period of time,ERCP has been accepted by more and more related patients.However,although ERCP has many advantages,its postoperative complications often make clinicians difficult,and the severity of its complications has also become an obstacle to its promotion and development.The related complications of ERCP include bleeding,perforation,postoperative pancreatitis,infection and so on.Among the many complications,the incidence of perforation is not high,but one of the most serious complications,once perforation occurs,if detection and treatment were not timely,it can lead to abdominal infection,intestinal fistula,bleeding and even death.At present,there are few reports on ERCP-related perforation at home and abroad compared with other complications,and there are different opinions on the prevention and treatment strategies of ERCP-related perforation.This study adopts retrospective analysis to analyze the clinical diagnosis and treatment of ERCP-related perforation,and discuss the methods of prevention and treatment,so as to make the related perforation patients get a satisfactory prognosis.ObjectiveIn this paper,the clinical data of patients with perforation diagnosed and treated by ERCP in our hospital from January 1st 2017 to December 31st 2020 were analyzed retrospectively,The clinical manifestations,imaging data,diagnosis,intraoperative data and treatment plans were analyzed in combination with the literature,so as to deeply understand the risk,possible risks and preventive diagnosis and treatment strategies of ERCP complicated with perforation,so as to provide reference for clinicians.MethodsSeven patients with perforation who underwent ERCP diagnosis and treatment in the first affiliated Hospital of Zhengzhou University from January 1st 2017 to December 31st 2020 were collected.The clinical data were collected and analyzed from many aspects,such as clinical manifestation,imaging manifestation,endoscopic manifestation,classification,treatment strategy,prevention strategy and so on.2127 patients who received ERCP in the Department of Gastroenterology of the first affiliated Hospital of Zhengzhou University from January 1st 2017 to December 31st 2020 were divided into two groups according to whether they had complications or not.7 patients with perforation were taken as perforation group,and 42 patients with similar age and sex were matched as control group according to the proportion of 1:6 in the other patients without perforation.There was no significant difference in age and sex between the two groups.The case data of the two groups were collected and statistically analyzed.The medical records include the general data of the patients and the data of intraoperative operation.General data include age,sex,choledocholithiasis,previous history of upper gastrointestinal surgery.The intraoperative data included balloon dilatation,net basket lithotripsy and flexion operation.These factors were analyzed by single factor analysis,and the factors with P<0.05 in single factor analysis were further analyzed by multi-factor analysis.All statistical analyses were performed by SPSS 20.0.the measurement data in accordance with normal distribution were expressed by(x±s),and t-test was used for comparison between groups.The counting data were expressed by rate.χ2 test was used for the analysis of counting data,and the factors with statistical significance in single factor analysis were analyzed by multivariate Logistic regression analysis.Result1.There were 5 patients with choledocholithiasis(57.1%),1 patient with benign stricture at the end of common bile duct(14.3%),and 1 patient with biliary tract occupying space(14.3%).There were 5 patients with Stapfer type Ⅰ perforation(71.4%),1 patient with type Ⅲ(14.3%)and 1 patient with type Ⅳ(14.3%),Perforation was found in 5 cases(71.4%)during operation and 2 cases(28.6%)after operation.1 patient(14.3%)received conservative treatment in internal medicine,6 patients(85.7%)received endoscopic treatment,and there was no surgical treatment.7 patients were cured and discharged from hospital.2.The risk factors of P<0.05in univariate analysis included balloon dilatation(P<0.026),flexion surgery(P<0.05)and previous upper abdominal surgery history(P<0.008).It was included in the multivariate analysis.Multiple stepwise Logistic regression analysis showed that the statistically significant factor for ERCP complicated with perforation was balloon dilatation(OR 0.057%CI0.003-0.942).In view of the small sample size of this study,the results still need to be demonstrated by clinical research.ConclusionFor ERCP-related perforation,it is very important to comprehensively evaluate the patient’s condition before operation and prevent the perforation,especially some operations that may cause perforation during the operation,which should be avoided.For the perforation that has occurred,early detection,early treatment and choosing the best individualized treatment according to the condition of the patient can often bring a better prognosis to the patients.endoscopic treatment is an effective treatment for some patients with perforation in time.For perforated patients who have lost the opportunity of surgical operation,color ultrasound or CT combined with endoscopic treatment is also a new clinical method.The number of patients with perforation in this study is relatively small,and the results of statistical analysis need to be further studied and demonstrated. |
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