急诊ERCP治疗老年人急性化脓性胆管炎48例临床分析

目的探讨急诊ERCP治疗高龄急性化脓性胆管炎患者的疗效及安全性。方法回顾性分析48例结石引起的高龄(≥70岁)急性化脓性胆管炎患者,分为ENBD组30例及EST组18例。ENBD组仅行ENBD,EST组同时行EST+取石术+ENBD。观察引流效果、取石成功率和并发症发生率。结果急诊ERCP引流有效共47例,成功率97.9%,其中ENBD组29例有效,成功率96.7%,EST组18例有效,成功率100%;引流有效率两组间无统计学差异(P>0.05)。一次性取石成功率EST组83.3%(15/18),ENBD组96.7%(29/30),ENBD组高于EST组(P<0.05)。ERCP相关并发症ENBD组1例(3.3%)、EST组2例(11.1%),EST组高于ENBD组(P<0.05);两组均无死亡患者。结论急诊ERCP治疗高龄急性化脓性胆管炎安全有效,且部分患者还能同时清除结石,应为首选治疗方案。

Analysis of 48 Cases of Emergency ERCP in Elderly Patients with Acute Suppurative Cholangitis

Objective To explore the effect and safety of elder patients with acute purulent cholangitis treated by emergency ERCP.Methods 48 elder patients(≥70years) with acute purulent cholangitis were reviewed retrospectively.The patients were divided into two groups;the ENBD group: 30 patients who underwent emergency ENBD only,and the EST group: 18 patients who underwent emergency ERCP included stones removal after EST and subsequent ENBD.The drainage effect,stone removal success rate and complication were recorded in both groups.Results Drainage efficiency was got 97.9% success rate in total 48 cases,which ENBD group 29 cases,the success rate of 96.7%,18 cases of EST Group,the success rate of 100%.There was no significant difference between the two groups(P>0.05).The success rate of stone removal one-time in EST group was 83.3%(15/18),ENBD group 96.7%(29/30).The ENBD group was higher than the EST group(P<0.05).The ERCP-related complications occurred 1 cases(3.3%) in the ENBD group,2 cases(11.1%) in the EST group,respectively.the EST group was higher than the ENBD group in complications(P<0.05).No death in both groups.Conclusion The emergency ERCP is an effective and safe method for elderly patients with acute suppurative cholangitis,and should be the preferred treatment option.