老年人胆总管结石的内镜治疗

目的：探讨老年人胆总管结石的内镜治疗的特点、疗效及随访结果。方法：回顾分析我院近5年来709例老年人胆。总管结石的内镜治疗及部分病人随访隋况。结果：本组709例ERCP全部成功，其中有57例深插管困难者采用十二指肠乳头剥脱开窗术而成功，所有病人均显示有胆总管结石，合并胆囊结石198例；其中单发结石345例，2枚结石211例,3枚以上结石153例，取石网篮直接取石372例，碎石后取石302例，应急碎石20例,未取结石直接于胆总管放置塑料支架15例。一次取尽结石569例，放置鼻胆管引流后二次取石125例。37例术中乳头括约肌电切时发生渗血，经局部喷洒去甲肾上腺素、局部黏膜下注射1：10000肾上腺素或局部电针电凝后出血停止，有15例术后48h于十二指肠乳头切口发生出血，10例给予黏膜下注射1：10000肾上腺素，5例给予钛夹止血。63例术后出现一过性淀粉酶升高而无腹痛，26例发生术后轻症胰腺炎，1例并发重症急性胰腺炎，均给予禁食、抑制胰液分泌抑制胰酶活性、抗炎补液等治疗后痊愈。有9例并发胆管炎，给予抗炎对症治疗，所有患者均痊愈出院。对其中498例病例随访6月～24月，有32例（6．43％）结石再发而再次内镜治疗。结论：老年胆总管结石患者内镜治疗安全有效，并发症发生率低。

Endoscopic Therapy for Common Bile Duct Stones:Results in Elderly Patients

Objective:To explore the applicability,safety and efficacy of endoscopic therapy for the treatment of common bile duct stones in the elderly;Methods:Retrospective analysis was performed in 709cases of common bile duct stones at our hospital in the lasted 3 years.Results:ERCP was performed in all of 709 patients,of which 57 cases difficult to undergo deep cannulation of bile duct had a pre-cut sphincterotomy successfully.All of the patients had the common duct stones,of which 198 were also combined with cholecystolithiasis.345 had one stone,211 two stones,and 153 had more than three stones.Calculus was removed using basket directly in 372 patients and using balloon catheter in 302.15 cases placed plastic stent without calculus removal.Errhysis occurred in 37 operations which was healed by partly sprinkling or injecting noradrenaline,or electric coagulation.Bleeding happened in 6 patients after operation for 48 h,of which 10 was treated with the inject of noradrenaline and 5 with titanium clipper.ERCP post- pancreatitis occurred in 27 patients,of which 26 were mild and one was sever.Nine patients were complicated with cholangeitis. They were cured with the internal medicine expectant treatment.498 of them were followed up for six months and two years,thirty-two patients recured and were treated again;Conclusions:Endoscopic therapy is safe and efficient for the treatment of common bile duct stones in the elderly,with the low rate of complications.