ERCP合并EST治疗老年胆总管结石256例分析

目的分析内镜逆行性胰胆管造影(ERCP)合并内镜乳头括约肌切开术(EST)治疗老年胆总管结石的临床疗效并讨论其临床意义。方法回顾性分析老年胆总管结石患者256例,通过ERCP掌握患者结石特征,并经内镜乳头括约肌切开术(EST)进行取石治疗。结果 256例胆管结石患者插管成功249例(97.27%),EST取石成功239例(93.36%),其中1次成功后取石199例(83.26%),2次成功40例(16.74%)。有7例患者(2.73%)因多发憩室,乳头位置不佳插管失败转手术治疗。ERCP合并EST后行内镜下鼻胆管引流术(ENBD)64.44%(154/239),引流3~5 d后造影证实结石取净90.91%(140/154)拔除了引流管,14例(9.09%)残余结石行2次内镜取石。术后并发症15例(6.02%),包括急性胰腺炎9例,胆道感染6例,给予相应治疗1周后痊愈。出现一过性血淀粉酶升高39例未做特殊处理,3 d后恢复正常。结论老年胆总管结石行ERCP(或EST)耐受性好,疗效显著且恢复快,有条件医院可以推广应用。

Clinical analysis on combination therapy of ERCP and EST for elderly patients with choledocholithiasis in 256 cases

Objective Objective To analysis the clinical curative effect on elderly patients with choledocholithiasis by endoscopic retro- grade cholangiopancreatography （ERCP） and endoscopic sphincterotomy （EST） and discuss its clinical significance. Methods 256 patients with choledocholithiasis were collected for diagnosis and treatment by ERCP. The stone characteristics was mastered by ERCP and the pa- tients were treated with EST. Results Patients with choledocholithiasis were successful in 249 cases （97.27%） for ERCP intubation and 239 cases （93.36%） for stone remove. After EST,the stones were removed successfully at one time in 199 cases （83.26%） ,2 times in 40 cases （ 16.74% ）. 7 patients （2.73%） with muhiple diverticulum and papillary position poor by intubation failure were changed over to op- eration treatment. After ERCP,patients were performed endoscopic nasobiliary drainage （ENBD） 64.44% （154/239）. Pull out the drain- age tube of 90.91% （ 140/154 ） of the patients after stones disappeared which was proved by angiography for 3 - 5 days. 14 cases （9.09%） were performed second times to remove the stones due to the presence of residual stones. Postoperative complications occured in 15 eases （6.02%） including 9 eases of acute pancreatitis and 6 eases of infection of biliary tract, and they were cured after 1 week of corresponding treatment. Transient increase of serum amylase occurred in 39 eases, and all of them recoveried after 3 days without special treatment. Con- clusion The results showed that ERCP （ or EST） were well tolerated by elderly patients with choledocholithiasis, and they were of obvious curative effect and quick recovery, which is worthy of promotion and application.