系统回顾：ERCP的罕见并发症-肝血肿的特点、诊断、治疗和预后
背景：肝血肿（HH）是一种罕见但是十分严重的ERCP术后不良事件。
目的：进行文献系统回顾并结合2例病例进行描述，其中1例在ERCP术后出现多发被膜下/肝内血肿。
方法：通过检索PubMed/MEDLINE，EMBASE，和 SCOPUS数据库，查找所有报道了ERCP术后肝血肿的病例。
结果：总共包含48例病人（女性63%，平均年龄58.2 ± 20.6岁）。平均发病时间为ERCP术后46.8小时，最常见症状为腹痛（91.7%），贫血（43.8%），低血压（29.2%）和发热（20.8%）。所有病例均由CT诊断。肝血肿最多发生于肝右叶（95.1%），平均大小为116 × 93 mm。38.3%的病例选择保守治疗，31.9%的病例需要经皮穿刺引流，14.9%需要介入栓塞，25%需要外科手术。死亡率大约9%。仅贫血(OR 6.9; p = 0.02)和外科手术(OR10.5; p < 0.01)是预后不良（死亡）的独立因素，而腹痛(OR 0.1; p = 0.03)和抗生素治疗(OR 0.06; p < 0.001)与较好预后相关。
结论：肝血肿是一种罕见但是十分严重的ERCP术后并发症，需要多学科干预。抗生素治疗是唯一能降低死亡风险的治疗方法。
Systematic review: Features, diagnosis, management and prognosis of hepatic hematoma, a rare complication of ERCP
N Imperatore ， G Micheletto ， G Manes, et al. Dig Liver Dis (2018)
Background: Hepatic hematoma (HH) is a rare but severe adverse event following endoscopic retrograde cholangiopancreatography (ERCP).
Aims: To perform a systematic literature review and describe two additional cases, one of which presenting multiple subcapsular/intrahepatic hematomas after ERCP.
Methods: The literature review was performed in PubMed /MEDLINE, EMBASE, and SCOPUS to identify all cases reporting on HH after ERCP.
Results: A total of 48 cases (females 63%, mean age 58.2 ± 20.6 years) were included. The mean symptoms onset time was 46.8 h after ERCP, and the most common symptoms were abdominal pain (91.7%), anaemia(43.8%), hypotension (29.2%) and fever (20.8%). All cases were diagnosed by computed tomography (CT).HH was found mostly in the right hepatic lobe (95.1%) and the mean size was 116 × 93 mm. A conservative management was adopted in 38.3% of cases, while percutaneous drainage, embolization and surgery were needed in 31.9%, 14.9% and 25%. Mortality rate was about 9%. Anaemia (OR 6.9; p = 0.02) and surgery (OR10.5; p < 0.01) were the only independent factors for unfavorable outcome (death), while abdominal pain(OR 0.1; p = 0.03) and antibiotics administration (OR 0.06; p < 0.001) were associated with better outcome.
Conclusions: HH is a rare but severe complication following ERCP which needs a multidisciplinary approach. Antibiotics administration is the only treatment able to reduce the risk of death.
翻译：王浩 审校：张立超、侯森林
