肝胆胰外科杂志2026，Vol.38Issue(9)：656-661,6.DOI:10.11952/j.issn.1007-1954.2026.09.008
ERCP相关十二指肠穿孔的诊治与预后分析
ERCP-related duodenal perforation:A retrospective analysis of diagnosis,management,and prognosis
摘要
Abstract
This study aimed to analyze the clinical characteristics of patients with duodenal perforation after endoscopic retrograde cholangiopancreatography(ERCP)and to explore the corresponding diagnosis and treatment strategies.Eighteen patients with ERCP-related duodenal perforation who were treated at or consulted by the Department of Biliary and Pancreatic Surgery,the First Affiliated Hospital of University of Science and Technology of China,from January 2017 to December 2025,were retrospectively enrolled in this study.The clinical manifestations,imaging findings,treatment interventions,and prognosis were analyzed.Of the 18 patients,16 perforations occurred during the ERCP procedure.Isolated scope-related injury accounted for only 3 cases(16.7％),whereas the remaining cases were mostly associated with combined procedures,such as endoscopic sphincterotomy(EST)/endoscopic papillary balloon dilation(EPBD)with stone extraction and/or endoscopic nasobiliary drainage(ENBD),and pancreatic duct stenting/occupying techniques;2 cases were caused by post-procedural stent migration.Perforation was detected intraoperatively in 6 cases(33.3％),within 24 h after ERCP in 5 cases(27.8％),between 24 and 48 h in 2 cases(11.1％),and after 48 h in 5 cases(27.8％).The initial treatment was surgery in 11 cases(61.1％),endoscopic therapy in 3 cases(16.7％),conservative management in 3 cases(16.7％),and interventional drainage in 1 case(5.6％).According to the Stapfer classification,type Ⅰ perforation was identified in 5 cases(27.8％),type Ⅱ in 3 cases(16.7％),type Ⅲ in 1 case(5.6％),type Ⅳ in 4 cases(22.2％),and the remaining 5 cases(27.8％)could not be definitively classified.The presumed perforation sites were mainly the lateral duodenal wall,periampullary region,and diverticulum-related areas;type Ⅳ perforations typically manifested as retroperitoneal or intraperitoneal free air on imaging.Overall,15 patients(83.3％)were discharged after recovery,and 3 patients(16.7％)died in hospital.All deaths occurred in the group initially treated with surgery(3/11,27.3％)and were associated with advanced age,delayed diagnosis and intervention,and severe infection or hemorrhage.In this series,ERCP-related duodenal perforation was predominantly caused by combined procedures;delayed diagnosis was observed in a subset of patients,and types Ⅰ and Ⅳ perforations were common.Mortality was mainly related to advanced age and delayed intervention.Therefore,the management of this complication should follow the principles of"early diagnosis,dynamic assessment,and stratified intervention",with treatment strategies selected comprehensively based on the patient's condition.Perioperative infection control and multidisciplinary collaboration should be emphasized to reduce the incidence of severe complications and mortality.关键词
内镜逆行胰胆管造影/十二指肠穿孔/外科手术/介入治疗Key words
endoscopic retrograde cholangiopancreatography/duodenal perforation/surgical treatment/interventional treatment分类
医药卫生引用本文复制引用
孙永涛,王刚,石向阳,程敏,徐世波,王成..ERCP相关十二指肠穿孔的诊治与预后分析[J].肝胆胰外科杂志,2026,38(9):656-661,6.基金项目
国家自然科学基金青年基金(82203856) （82203856）
安徽省重点研究与开发计划(2022e07020006) （2022e07020006）
中国科学技术大学附属第一医院医疗领先技术引进项目(2023LXJS-05). （2023LXJS-05）
