十二指肠镜治疗高龄急性胆源性胰腺炎的临床应用

目的探讨应用十二指肠镜治疗高龄急性胆源性胰腺炎患者的可行性、有效性和安全性。方法该院2002年5月-2005年10月收治的18例高龄急性胆源性胰腺炎患者首先行内镜下乳头括约肌切开取石，同时置入鼻胆管引流；合并胆囊结石者，待胰腺炎恢复后，施行腹腔胆囊切除术等。结果全组18例病人均行鼻胆管引流（ENBD），11例胆管结石行内镜下乳头括约肌切开取石（EST）取出，胰腺炎顺利治愈17例，治愈率94．4％：6例取石失败。二次内镜治疗行胆道支架引流术、三镜联合胆总管探查术，中转开腹手术治疗，无严重术后并发症发生。结论早期ENBD＋EST，解除胆道梗阻，降低胰管压力，避免急诊手术，为择期手术创造条件，该微创技术尤为适合高龄、合并有多脏器功能不全、难以耐受手术的患者。

Clinical Application of Duodenoendoscopy for treatment of elder patients with acute gallstone pancreatitis

Objective] To investigate the probability, efficacy and safty of duodendoscopy for the treatment of severe acute gallstones pancreatitis in the elder people. Methods] From May 2002 to October 2005, 18 patients with acute gallstone pancreatitis were treated by endoscope sphincterotomy(EST) and endoscope nasobiliary drainage(ENBD). Laparoscopic cholecystectomy(LC) was carried out in the cases with cholelithiasis after recoveligfrom pancreatitis. Results] Among the 18 cases, 11 cases underwent EST to remove the stone. ENBD was carried out in all the cases. 17 cases were cured with the effective rate of 94.4. 6 cases were respectively performed secondly endoscopic retrograde biliary drainage (ERBD), tri-scopy common bile duct exploration, traditional operation after failing to remove the stone and there was no complication. Conclusion] Early-performing EST and ENBD could avoid emergency operation on the basis of relieving obstruction of biliary tract and inducing pressure of pancreatic duct. They were suitable for elder patients with multiple organ-dys functionsyndrome or hard to tolerate operation because of minimal invasiveness.