治疗性经内镜逆行胰胆管造影在高龄人群胆总管结石中的应用(附91例临床分析)

目的评价内镜治疗70岁以上胆总管结石患者的安全性及有效性。方法回顾性分析2004年1月～2010年12月我院内镜中心91例70岁以上胆总管结石患者的内镜诊治资料及随访情况。结果 91例患者经内镜逆行胰胆管造影(ERCP)全部成功,其中18例因插管困难行十二指肠乳头括约肌预切开术。所有患者均有胆总管结石,其中1枚结石者48例,2枚结石者19例,3枚或3枚以上结石者24例;取石方法:网篮直接取石13例,机械碎石后取石52例,球囊扩张后取石11例;胆总管放置塑料支架而未能一次取石15例。胆总管结石直径1.4～4.5 cm,平均(1.9±0.7)cm。7例出现出血并发症,应用局部喷洒或黏膜下注射1∶10 000肾上腺素、局部电凝方法止血;11例患者术后出现一过性淀粉酶升高,2例患者发生ERCP相关胰腺炎,上述患者行禁食、抑制胰液分泌、抑制胰酶活性、抗炎补液等治疗。入组患者无ERCP相关性死亡,89例患者随访6～12个月,2例失访,5例出现结石再发。结论内镜下治疗高龄胆总管结石患者疗效确切,安全性较好。

Therapeutic ERCP in geriatric population with common bile-duct stones(report of 91 cases)

Objective To retrospectively evaluate the safety and efficacy of therapeutic ERCP in geriatric population(aged 70 years and older) with common bile-duct stones.Methods All patients(aged 70 years and older) with choledocholithiasis in whom a therapeutic ERCP had been performed over a five-year period of time(2004-2010) were retrospectively studied.Results ERCP was performed in all of the 91 patients of which 18 cases underwent a pre-cut sphincterotomy for difficulties in the deep cannulation of the bile duct.All of the patients had common bile duct stones,48 had one stone,19 had two,and 24 had more than three stones.Calculus were removed using basket directly in 13 patients,balloon catheter in 8,lithotrity in 52,and 15 cases were placed with plastic stent without calculus removal.Stone diameter was 1.4-4.5 cm(1.9±0.7 cm).Bleeding occurred in 7 cases,all of them were mild and were cured by using submucous injection of noradrenaline(1∶10 000) or electric coagulation.Post-ERCP pancreatitis occurred in 11 patients,2 were severe.No ERCP related deaths occurred.89 cases were followed up for 6~12 months and two cases were lost,5 cases had recurrence of stones.Conclusion Therapeutic ERCP Proved to be a feasible treatment option for the management of choledocholithiasis in the elderly.