陈男男　综述　张学彦　审校

哈尔滨医科大学附属第二医院消化内科(150001)



内镜下乳头括约肌切开术后出血治疗方法

陈男男*综述张学彦#审校

哈尔滨医科大学附属第二医院消化内科(150001)

*在读硕士研究生，Email: 734785123@qq.com

#本文通信作者，Email: zxycxw@sina.com

摘要近年来，胆胰疾病的诊治越来越多地依赖于内镜技术，ERCP和内镜下乳头括约肌切开术(EST)相关并发症的问题日渐凸显。术后出血为EST的严重并发症之一，其一线治疗包括各种内镜下操作，如肾上腺素或纤维蛋白胶注射止血、电凝或热探头止血、钛夹止血、覆膜支架置入等，如内镜治疗失败，可考虑行经导管动脉栓塞或外科手术治疗。本文就上述EST术后出血的治疗方法作一综述。

关键词乳头肌；括约肌切开术，内镜；出血；治疗

Treatment of Post-endoscopic Sphincterotomy Bleeding

CHENNannan,ZHANGXueyan.

DepartmentofGastroenterology,theSecondAffiliatedHospitalofHarbinMedicalUniversity,Harbin(150001)

Correspondence to: ZHANG Xueyan, Email: zxycxw@sina.com

AbstractIn recent years, endoscopic technique has become a basic procedure for the diagnosis and treatment of biliary and pancreatic diseases, thus the procedure-related complications of ERCP and endoscopic sphincterotomy (EST) become prominent day by day. Post-EST bleeding is one of the most serious complications of the procedure, and its first line treatment involves a variety of endoscopic techniques, such as epinephrine or fibrin glue local injection, electric coagulation and heat probe, clamps and covered metal stents. If these are not successful, transcatheter arterial embolization or surgical operation should be considered. In this article, the above-mentioned treatment modalities of post-EST bleeding were reviewed.

Key wordsPapillary Muscles;Sphincterotomy, Endoscopic;Hemorrhage;Therapy

1974年，Kawai等[1]以及Classen和 Demling分别报道了以推式刀和拉式弓形刀行内镜下乳头括约肌切开术(EST)，这一治疗性ERCP技术发展至今已有40余年的历史。近年来，胆胰疾病的诊治越来越多地依赖于内镜技术，ERCP和EST相关并发症的问题日渐凸显。EST的常见并发症有胰腺炎、胆管炎、出血、穿孔等[2-3]，据报道，术后出血发生率为2%~5%，较大量出血发生率为1.9%，病死率为0.1%~0.3%[4]。EST术后出血的一线治疗包括各种内镜下操作，如药物注射止血、电凝或热探头止血、钛夹止血、覆膜支架置入等，对发生于术后24 h之后的迟发性出血亦有显著疗效，如内镜治疗失败，可考虑行经导管动脉栓塞(TAE)或外科手术治疗[3-6]。本文就EST术后出血的治疗方法作一综述，以期为其临床治疗提供参考。

一、内镜治疗