Treatment for 63 cases of the elderly with choledocholith by duodenoscope

Objective To explore the effect of duodenoscope in the treatment for the elderly cases.Method Retrospective analysis of the treatment by duodenoscope for 63 elderly patients (all aged over 80 years old) with high risk choledocholith from Jan 2006 to Dec 2010.Results All of the 63 cases obtained a success in the endoscopic operation.The operative time was within 15~60 min.Endoscopic stone extraction was performed on 21 cases,bile duct plastic stent in 35,of them 2 cases had the second operation because their stones were too big.In 2 cases of 9 who suffered from acute obstructive suppurative cholangitis (AOSC),plastic stents were placed.In the rest 7 cases,nasobiliary drainages (NBD) were inserted,on 4 of the 7 cases,stone extraction were performed 5-7 days later,in 3 of the 7 cases,stents were inserted for the second time,of the 3 cases,2 were found blood oozing on the surface of wound after EST (endoscopic sphicterectomy),the bleeding was stopped by local spray of noradrenaline,no hematorrhea or perforation occurred.Postoperative choledochitis was found in 1 case,to whom anti inflammatory therapy was applied.Pancreatitis was found in 3 cases,blood amylase increasing in 12,who were cured with fast,pancreatic secretion inhibition and anti inflammatory drugs.One patient died of acute left heart failure (ALHF),no death from the bile duct diseases or concerned were found.Conclusion Although many basal diseases of the elderly increase the risks in the endoscopic treatment,it proves to be practical for it has less complications,high security and definite curative results.     

胆道塑料支架治疗高龄高危胆总管结石患者

目的 探讨十二指肠镜下胆道塑料支架治疗高龄高危胆总管结石患者的效果.方法 对从2006 年1月至2009 年12 月行胆道塑料支架引流的49 例高龄胆总管结石患者进行回顾性分析.结果 本组病例均顺利完成胆道支架置入,术后24~48 h 患者腹部体征好转,发热症状缓解,术后1~2 周患者黄疸基本恢复正常出院.出院后随访,患者中出现腹痛,发热,黄疸等胆总管结石相关症状28 例,其中15 例经抗炎治疗后好转,13 例反复出现上述症状,经内镜再次治疗后好转.14 例患者未再出现胆总管结石相关症状,无胆道疾病及支架相关原因引起的死亡.结论 对于高龄高危胆总管结石患者无法耐受或不愿手术的及不能耐受较长时间内镜下取石的,行胆道塑料支架引流是一种简单、有效、安全的治疗措施,短期疗效显著.长期引流需密切随访,发现支架阻塞脱落并出现临床症状者及时行更换或再次置入支架等处理.