ERCP胆道塑料支架置入术与ERCP胆道取石术治疗老年多发胆总管结石的临床效果比较

目的比较内镜下逆行胰胆管造影(ERCP)胆道塑料支架置入术与ERCP胆道取石术治疗老年多发胆总管结石的临床效果。方法将2017年1月至2018年12月我院收治的168例多发胆总管结石的老年患者按手术方法的不同分为支架组(n=75)和取石组(n=93)。支架组行ERCP+内镜下乳头括约肌切开术(EST)+胆道塑料支架置入术,取石组行ERCP+EST+胆道取石术+内镜下鼻胆管引流术。比较两组生化指标、近远期并发症发生情况、手术时间、住院时间及住院费用。结果两组患者术前1 d及术后1、3、5 d的WBC、CRP、ALT、TBIL、γ-GT水平比较,差异无统计学意义(P>0.05)。两组患者的死亡率及术后胰腺炎、术后胆管炎、消化道出血的发生率比较,差异无统计学意义(P>0.05);支架组的反复胆系感染、再次ERCP手术发生率均高于取石组,差异具有统计学意义(P<0.05)。支架组患者的手术时间短于取石组,住院费用低于取石组,差异具有统计学意义(P<0.05)。结论ERCP胆道塑料支架置入术和ERCP胆道取石术治疗老年多发胆总管结石都是安全、有效的,应根据患者情况选择合适的手术方式。

Comparison of the clinical effects of plastic biliary stent placement through ERCP and biliary lithotomy through ERCP in the treatment of elderly patients with multiple choledocholithiasis

Objective To compare the clinical effects of plastic biliary stent placement through endoscopic retrograde cholangiopancreatography(ERCP)and biliary lithotomy through ERCP in the treatment of elderly patients with multiple choledocholithiasis.Methods From January 2017 to December 2018,168 elderly patients with multiple choledocholithiasis enrolled in the our hospital were divided into stent group(n=75)and lithotomy group(n=93)according to the different surgical methods.The stent group underwent ERCP+endoscopic sphincterotomy(EST)+plastic biliary stent placement,while the lithotomy group underwent ERCP+EST+choledocholithotomy+endoscopic nasobiliary drainage.Biochemical indexes,short-term and long-term complications,operation time,hospital stay and hospitalization cost were compared between the two groups.Results There were no significant differences in WBC,CRP,ALT,TBIL andγ-GT levels between the two groups at 1 d before operation and at 1,3,5 d after operation(P>0.05).There were no significant differences in the mortality and incidences of postoperative pancreatitis,postoperative cholangitis and gastrointestinal bleeding between the two groups(P>0.05);the incidences of repeated biliary tract infection and ERCP operation in the stent group were higher than those in the lithotomy group,and the differences were statistically significant(P<0.05).The operation time of the stent group was shorter than that of the lithotomy group,and the hospitalization cost was lower than that of the lithotomy group,and the differences were statistically significant(P<0.05).Conclusion The plastic biliary stent placement through ERCP and biliary lithotomy through ERCP in the treatment of elderly patients with multiple choledocholithiasis are safe and effective.Appropriate surgical methods should be selected according to the patients'condition.