ERCP治疗90岁以上高龄患者胆总管巨大结石疗效

 目的 探讨内镜逆行胰胆管造影术(ERCP)治疗90岁以上患者胆总管巨大结石(LCBDS)(结石直径＞1.5 cm)的效果及安全性。方法 对2002-02至2022-06在解放军总医院第一医学中心接受治疗性ERCP的28例90岁以上(高龄组)和46例18~64岁(非老年组)的LCBDS患者进行回顾性研究,分析其临床特点、ERCP术中治疗程序及其疗效和术后并发症。结果 与非老年组相比,高龄组患者的急性生理和慢性健康评分(APACHE-Ⅱ),差异有统计学意义(P<0.001),ASA高分级(≥3) 和急性胆管炎更常见(P<0.001)。两组在性别比例、年龄校正查尔森合并症指数(aCCI)、巨大结石发生率(直径＞2.0 cm)、胆管多发结石、壶腹周围憩室、乳头括约肌预切开、乳头括约肌切开术(EST)、内镜下乳头大球囊扩张术(EPLBD)、取石球囊术、取石网篮术、碎石术、胆道支架置入及鼻胆引流管置入方面,差异均无统计学意义。两组患者一次取石成功率、临床成功率及术后并发症发生率,差异均无统计学意义。结论 ERCP可以安全而有效治疗90岁以上患者的胆总管巨大结石。

Effectiveness and safety analysis of ERCP in patients aged 90 years and above with large common bile duct stones

Objective To investigate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of patients over 90 years old with large choledocholithiasis (LCBDS) (diameter>1.5 cm). Methods A retrospective study of 28 patients aged over 90 years (senior group) and 46 patients aged 18~64 years (non-senior group) with primitive papillae and LCBDS who underwent therapeutic ERCP at the First Medical Center of the PLA General Hospital from February 2002 to June 2022 was conducted to analyze their clinical characteristics, preoperative examination, ERCP procedures and postoperative complications. Results Higher acute physiology and chronic health evaluation (APACHE-II)、ASA classification (≥3) and acute cholangitis were more common in the senior group (P<0.001). There was no statistically significant difference in the gender ratio, aCCI, stone diameter >2.0 cm, multiple stone, periampullary diverticulum, endoscopic sphincterotomy (EST), endoscopic papillary large balloon dilation (EPLBD), biliary stent or endoscopic nasobiliary drainage between the two groups (P>0.05). The differences in complete stone extraction rate at one time, clinical success rate and postoperative complications rate were not statistically significant between the two groups (P>0.05). Conclusions ERCP is a safe and effective treatment for large choledocholithiasis in patients over 90 years of age.