治疗性内镜下逆行胰胆管造影术在老年患者胰胆疾病中的临床应用

目的评价治疗性内镜下逆行胰胆管造影术(ERCP)在老年患者胰胆疾病中的临床应用。方法回顾分析总结成都大学附属医院2007年7月至2009年12月完成的73例70岁以上老年患者治疗性ERCP的临床治疗结果。结果 73例患者共完成治疗69例,成功率94.5%。胆管结石49例,胆管癌6例,胰头癌4例,乳头癌3例,乳头良性狭窄7例,失败4例。其中49例胆道结石组中,48例经乳头奥狄氏括约肌切开(EST)或气囊扩张乳头后,取石成功,7例合并急性梗阻性化脓性胆管炎,以及6例合并胆源性胰腺炎的患者症状均很快缓解。1例因结石较多并且合并肝内胆管结石,转外科行开腹手术,13例肿瘤组中,4例胰头癌、6例胆总管癌患者均安置金属支架,引流通畅,均顺利出院。本组无严重的并发症及死亡发生。结论经过认真的术前准备和术中监护及操作,治疗性ERCP对老年患者是安全和有效的,可代替部分传统开腹手术。

Clinical application of therapeutic ERCP in elder patients with pancreaticobillary diseases

Objective To investigate the clinical application of therapeutic endoscopic retrograde cholangiopancreatography（ERCP） in elder patients with pancreaticobillary diseases.Methods A retrospective study was performed to analyze the clinical effect of therapeutic ERCP in 73 cases（≥70 years old） of pancreaticobillary diseases in our hospital from July 2007 to December 2009.Results Therapeutic ERCP was accomplished in 69 of 73 cases,and the successful rate of the above treatments was 94.5%.Among the patients,there were 49 cases with common bile duct stones,6 cases with biliary duct cancer,4 cases with carcinoma of head of pancreas,3 cases with duodenal papillary cancer,7 cases with benign stricture of duodenal papilla succeeded and 4 cases failed.Stones were successfully moved in 48 of 49 cases with common bile duct stones through endoscopic sphincterotomy（EST） or balloon dilatation of duodenal papilla succeeded.All patients including 7 cases with acute obstructive suppurative cholangitis and acute biliary pancreatitis relieved immediately.Surgical operation was performed for one patient because there were too much stones and they were combined with intrahepatic biliary duct stones.Among 13 cases with tumors（4 cases with carcinoma of head of pancreas,6 cases with biliary duct cancer）,symptoms alleviated by placing metal stents for drainage.No patients died and there were no severe complications in the series.Conclusion By given good preparation before operation and close monitoring during operation,therapeutic ERCP is safe and effective for elder patients.Traditional surgery may be partly substituted by therapeutic ERCP in the treatment of patients with pancreaticobillary diseases.