内镜下逆行胰胆管造影在高龄急性胆囊炎患者中的临床应用

目的探讨内镜下逆行胰胆管造影（ERCP）在高龄（≥75岁）急性胆囊炎患者中的临床应用。方法回顾性分析2008年1月至2012年12月拟行ERCP治疗的75岁以上胆囊炎患者。本次急性发作时间为1～5 d,均经影像学（包括腹部超声、CT及磁共振）确诊为急性胆囊炎。所有手术患者均给予留置鼻-胆囊引流（ENGBD）,术后观察腹部体征、体温、C反应蛋白（CRP）,腹部影像学及记录胆囊引流情况,出院后定期随访。结果共有24名患者,其中男13例,女11例,年龄75～88岁,平均（81.0±3.2）岁接受ERCP检查,其中术前诊断18例为结石性胆囊炎（75.0%）,6例为非结石性胆囊炎（25%）,13例（54.2%）合并胆总管结石。所有患者均成功留置鼻胆引流管,21例（87.5%）于术后腹痛缓解,体温降至正常,CRP于术后6 d内均降至正常。2例（8.3%）术后出现高淀粉酶,3 d后降至正常。无ERCP相关穿孔、出血、术后胰腺炎、死亡等并发症出现。术后随访3～12个月,23例（95.8%）症状长期缓解,1例因症状反复出现行腹腔镜手术。结论对于无法行急诊手术的高龄急性胆囊炎患者,行ERCP留置鼻-胆囊引流管治疗是一种安全、有效的治疗方法。

Efficacy and safety of endoscopic retrograde cholangiopancreatography in aged and elderly geriatric patients to treat acute cholecystitis

Objective To retrospectively evaluate the therapeutic efficacy and safety of endoscopic retrograde cholangiopancreatography（ERCP） for treating acute cholecystitis in geriatric patients 75 years and older in age.Methods The clinical records of our institute were searched to identify aged（75-84 years old） and elderly（85 years and older） patients who underwent ERCP between January 2008 and December 2012 for new or long-term cholecystitis.The cholecystitis was clinically characterized as acute attack time（s） of one to five days and diagnosis was confirmed by imaging analysis（including abdominal ultrasound,computed tomography,and/or magnetic resonance cholangiopancreatography）.All surgeries were carried out with the endoscopic nasogallbladder drainage（ENGBD） procedure.Postoperative symptoms（such as abdominal pain and fever） and clinical findings（such as C-reactive protein（CRP） level,imaging findings,and bile drainage volume and consistency） were recorded,along with follow-up data of outcome and symptomology,for summary evaluation.Results A total 24 patients,including 13 men and 11 women between the ages of 75 and 88（mean： 81.00±3.23 years）,underwent ERCP examination.The cases included general cholecystitis（75.0%,n=18） and acalculous cholecystitis（25.0%,n=6）.In addition,13（54.2%） cases had biliary stones and two（8.3%） cases had bile pancreatitis.The ENGBD tube was successfully inserted into the gallbladder in all cases.Twenty-one（87.5%） patients experienced relief of abdominal pain and fever within 24 h of the surgery.CRP level decreased to normal for all（100%） patients within six days of the surgery.Two（8.3%） patients experienced hyperamylasemia within three days of the surgery,and both cases resolved prior to hospital release.There were no cases of ERCP-related hemorrhage,perforation,pancreatitis,or death.Follow-up time ranged from three to 12 months,during which 23（95.8%） patients showed long-term remission.The presence of persistent symptoms was addressed by laparoscopic cholecystectomy.Conclusion ERCP with the ENGBD procedure is an effective and safe treatment modality for acute cholecystitis in aged and elderly geriatric patients.