ERCP术后脾被膜损伤的病因和风险:病例报告和文献回顾(翻译)

时间:2018-08-10 作者:翻译:王浩 审校:张 点击:

ERCP术后脾被膜损伤的病因和风险:病例报告和文献回顾
摘要

背景和研究目的:ERCP是一项用于处理胰腺以及胆道相关疾病的侵入性诊断方法和介入治疗手术。ERCP有4%-10%的并发症发生率。严重的并发症很少,最常见的是术后胰腺炎、出血和穿孔。脾损伤是一种罕见但是具有潜在生命威胁的并发症。本篇报道了一例60岁因胆总管结石行ERCP后脾被膜损伤的病例。脾损伤的确切原因还不得而知,尽管有人提出了一些假设损伤机制。文献回顾后发现目前仅有3例ERCP术后脾被膜损伤的病例。本篇报道的病例是首例既没有高危因素,在ERCP过程中也没有任何技术困难的病例。当病人在ERCP后出现重度疼痛,贫血或出血性休克后需要高度怀疑脾损伤。
 结论:脾损伤是ERCP术后罕见的并发症。尽管很多病人完全恢复了,并发症同样是致命的。当病人有重度腹痛、进行性的贫血或严重的低血压症状时考虑到脾损伤尤为重要。这些症状可能术后立即出现也可能几天后出现。应该清楚的认识到即便ERCP手术没有技术困难也没有高危风险因素这种并发症也可能会出现。
 
(注:本篇报道病例患者在怀疑脾损伤后进行了急诊剖腹探查术emergent laparotomy,术中施行了脾切除和胆囊切除,患者术后恢复顺利,在ERCP术后11天时出院。)

Etiologies and risks of splenic decapsulation after endoscopic retrograde cholangiopancreatography: case report and literature review

Abstract
Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive diagnostic and interventional procedure used in conditions related to the pancreas and biliary tract. It has a complication rate ranging from 4 % to 10 %. Severe complications are few with the most common of them being post-ERCP pancreatitis, post-sphincterotomy bleeding, and perforation. A rare, but potentially life-threatening complication of ERCP is splenic injury. We report the case of a 60-year-old female with choledocholithiasis who sustained splenic decapsulation following ERCP. The exact causes of splenic injury are unknown, although several mechanisms are postulated. A literature review of splenic injuries post-ERCP shows that there are only 3 cases with post-ERCP splenic decapsulation. Our patient is the first one in whom splenic decapsulation occurred without any risk factors or technical difficulties during the procedure. A high index of suspicion for splenic injury is required in any patient who has severe pain, anemia, or hemorrhagic shock after ERCP.

Conclusion Splenic injury is a rare complication of ERCP. Although most patients recover completely, that complication can be fatal. It is important to consider splenic injury in any patient after ERCP who has increasing abdominal pain ,develops anemia or sever hypotension. These symptoms can present immediately or even days after the procedure. It is important to realize that this complication may occur even if ERCP was performed with no technical difficulty or risk factors. 

翻译:王浩 审校:张立超 侯森林  (Endosc Int Open 2018)