80岁以上高龄总胆管结石患者内镜下括约肌切开术治疗安全性探讨

The safety of endoscopic sphincterotomy in treatment of choledocholithiasis in patients over eighty years

目的探讨对80岁以上高龄总胆管结石患者进行内镜下括约肌切开术（EST）治疗的安全性。方法对2005—2007年进行EST治疗的总胆管结石患者，选择其中≥80岁的148例作为高龄组；≤60岁的745例作为对照组。比较两组患者的临床资料与手术成功率及手术后的并发症。结果①高龄组和对照组伴随疾病发生率为29．3％和8．1％，两组间差异有统计学意义（P〈0．01）；有前期胆道手术或内镜逆行胰胆管造影术史者分别为45．18％和21．3％，两组差异有统计学意义（P〈0．01）。②高龄组EST成功率为95．6％，对照组为96．5％，两组间差异无统计学意义（P〉0．05）。③高龄组术后并发症共16例（10．8％），其中EST本身并发症13例（占8．8％）；3例并发症与EST有关（占2％），1例死于吸人性肺炎。对照组术后发生EST本身并发症共41例（5．5%），未发生EST相关并发症。两组间EST本身的并发症发生率差异无统计学意义（P〉0．05），但与EST有关的并发症发生率差异有统计学意义（P〈0．01）。④术后平均住院时间，高龄组为（7．2±2．2）d，对照组为（5．1±1．4）d，两组间差异无统计学意义（P〉0．05）。结论对于80岁以上高龄总胆管结石患者，EST仍然是安全有效的治疗手段。

Objective To discuss the safety of endoscopic sphincterotomy （EST） in treatment of choledocholithiasis in patients over 80 years. Methods From 2005 to 2007, 893 patients with choledocholithiasis were divided into group A （n= 148, aged over 80 years） and group B （n= 745, aged below 60 years）. The clinical data, complications and EST successful rate were retrospectively reviewed between two groups. Results① The important chronic concomitant diseases were significantly higher in group A than those in group B （ 29.3% vs 8. 1% ,P〈0.01）. ② The EST successful rate in group A and B was 95.6%o and 96.5%, respectively （P〉0.05）. ③Sixteen patients in group A had complications including 13 caused by EST itself, 3 related with EST and one died of aspiration pneumonia. While in group B, 41 complications were caused by EST itself and no EST related complications. There was a statistically difference in EST related complications between two groups （P 〈0.01）. In complications caused by EST itself, there was no difference between two groups（P〉0.05）. ④ The average hospital stay was （7.2±2.2） days in group A and （5.1±1.4） days in group B with no significant difference （P〉 0.05）. Conclusion The EST is safe and effective in treatment of patients over 80 years.