内镜微创治疗80岁以上胆源性胰腺炎患者80例临床观察

目的探讨80岁以上胆源性胰腺炎患者内镜治疗的安全性和疗效。方法回顾性分析2006年1月-2013年10月成都军区总医院消化中心收治的80例大于80岁的胆源性胰腺炎患者资料,采用经内镜逆行胰胆管造影(ERCP)+十二指肠乳头括约肌切开术(EST)+鼻胆管引流(ENBD),或胆道塑料支架植入术治疗。结果 80例患者中,4例因镜下无法找到十二指肠大乳头开口而转为开腹手术,余76例均完成内镜治疗,成功率95%(76/80),其中2例死亡,病死率2.6%(2/76)。其中一次性完成ERCP+EST+ENBD治疗者69例,7例因较大铸型结石嵌顿无法碎石而行胆道塑料支架植入;1例因感染性休克死亡,1例因反复消化道出血死亡。结论内镜治疗高龄胆源性胰腺炎患者具有创伤小、恢复快、病死率低的优点,是一种安全有效的治疗方法。

Clinical effect of endoscopic retrograde cholangiopancreatography in 80 elderly patients with biliary pancreatitis

Objective To investigate the safety and efficacy of endoscopic retrograde cholangiopancreatography （ERCP）treatment in elder-ly patients with biliary pancreatitis.Methods A retrospective analysis was performed on 80 elderly patients （more than 80 years old）with biliary pancreatitis who were admitted to our center from January 2005 to December 2013.The patients were treated with a combination of ERCP,endoscopic sphincterotomy （EST）,and endoscopic nasal biliary drainage （ENBD）,or treated with plastic biliary stent implanta-tion.Results ERCP treatment was successful in 76 （95%）of the 80 patients,while the other 4 patients were converted to open surgery because of failure to identify the major duodenal papilla endosopically.The mortality rate from ERCP treatment was 2.6%（2/76）,with the causes of death being septic shock and repeated gastrointestinal bleeding,respectively.The first ERCP＋EST＋ENBD treatment was suc-cessfully performed in 69 of the 76 patients,while the other 7 patients were treated with plastic biliary stent implantation due to unremovable large cast stones.Conclusion ERCP treatment leads to small trauma,quick recovery,and low mortality in elderly patients with biliary pan-creatitis,suggesting that it is a safe and effective therapy.