高龄胆总管结石患者ERCP取石术疗效分析及安全性评估

目的探讨高龄胆总管结石患者行ERCP取石术的疗效及安全性。方法对58例70岁以上胆总管结石患者行ERCP取石术，观察其取石成功率、并发症发生率、治疗后1周肝功能变化、黄疸消退及住院时间，并与同期46例行传统外科手术治疗的患者比较。结果两组患者均无死亡。ERCP组取石成功率为879％（51／58），并发症发生率为8．6％（5／58），黄疸消退时间为（7．2±1．5）d、住院时间为（9．2±2．6）d，而传统手术组分别为89．1％（41／46）、8．7％（4／46）、（14．3±2．9）d、（15．0±37）d。两组取石成功率和并发症发生率的差异无统计学意义（均P〉0.05），但ERCP组黄疸消退时间和住院时间均明显缩短（均P〈0.01），治疗后1周血TBIL和DBIL的下降更为明显（均P〈0．05）。结论对高龄胆总管结石患者行ERCP取石安全性好，并发症发生率低，疗效确切，较传统的外科手术取石引流能减轻创伤、缩短治疗时间。

Evaluation of efficacy and safety of calculus extraction by ERCP in aged patients with choledocholithiasis

Objective To evaluate the efficacy and safety of calculus extraction by endoscopic retrograde cholangiopancreatography （ERCP） in elderly patients with choledocholithiasis. Methods Fifty eight patients with choledo-cholithiasis aged over 70 underwent ERCP to remove their calculi. The successful rate, complication rate, hepatic function changes one week after ERCP, the time of jaundice regression and length of hospital stay were analyzed, and were compared with those in 46 patients treated by routine surgery during the same period. Results There was no death in both groups. In ERCP group, rate of success was 87.9% （51/58）, complication rate was 8.6%（ 5/58 ）, jaundice regression time was（ 7.2±1.5 ） d, and the length of hospital stay was （ 9.2±2.6 ）d; those were 89.1%（41/46）, 8.7%（4/46）,（ 14.3±2.9 ）d and （ 15.0±3.7 ）d in routine surgery group, respectively. There were no significant differences in successful rate of calculus extraction and complication rate between the two groups （P〉0.05）. But jaundice regression time and the length of hospital stay were significantly lower in ERCP group （P〈0.01）, and the decrease of TBIL and DBIL were more significant in ERCP group（P〈 0.05 ）. Conclusion The extraction of calculi by ERCP in the aged patients with choledocholithiasis can minimize invasiveness and reduce the length of hospital stay, which is safe and effective.