老年人胆管结石内镜下括约肌切开预防并发症及疗效分析

目的分析内镜下括约肌切开术(EST)在老年人胆管结石治疗中的疗效及常见并发症的预防。方法选择2011年1月至2014年2月因胆管结石行EST治疗156例患者,通过内镜逆行胰胆管造影(ERCP)诊疗,了解及掌握其操作流程、治疗方法及并发症的预防。结果本组患者均ERCP插管成功,操作取石,术后常规留置鼻胆引流管。近期(3 d内)并发症23例(14.7%),其中注入性胰腺炎8例(5.1%),胆道感染2例(1.2%),术后出血1例(0.6%),淀粉酶升高8例(5.1%),上腹胀痛、呕吐4例(2.5%);远期(1~3个月)并发症18例(11.5%),其中周期胆道感染12例(7.6%),反复胰腺炎6例(3.8%)。术后1年随访36例患者(23.1%),其中18例(50.0%)再次出现胆管结石,考虑结石复发。结论老年人胆管结石行EST治疗优势,值得临床广泛推广。

Endoscopic sphincter incision in treating bile duct stones and preventing complications in elderly patients

Objective To analyze the efficacy of endoscopic sphincter incision ( EST ) in the treatment of elderly patients with bile duct stones and the prevention of common complications . Methods From January 2011 to February 2014, 156 patients with bile duct stones were treated by EST , and the purpose of this study was to understand the operation flow , treatment methods and prevention of complications . Results ERCP was successfully performed in this group of patients , in addition to lithotomy, postoperative routine indwelling of a nasal biliary drainage tube . Short-term ( 3 days ) complications occurred in 23 ( 14.7%) patients, in which 8 ( 5.1%) patients developed injected pancreatitis, 2(1.2%)patients developed biliary tract infection , 1(0.6%) patient developed postoperative bleeding, 8(5.1%) patients developed amylase, and 4(2.5%)patients developed abdominal pain and vomiting.The long-term complications (3 months) were discovered in 18 (11.5%) patients.Biliary tract infection was found in 12 (7.6%) patients, and recurrent pancreatitis in 6(3.8%).Thirty-six (23.1%) patients were followed up after operation .Bile duct stones were found in 18 (50.0%) patients, and they were considered as recurrent stones . Conclusion EST is superior in the treatment of elderly patients with bile duct stones and is worth popularizing .