90岁及以上胆总管结石患者内镜疗效分析

A retrospective study of endoscopic extraction of gallstones in common bile duct in 37 cases aged 90 years and over

目的 探讨经内镜十二指肠乳头括约肌切开术（EST）及胆道塑料支架置入（ERBD）治疗90岁及以上患者胆总管结石的疗效及安全性.方法 对37例行EST及ERBD治疗胆总管结石的90岁及以上患者的临床资料进行回顾性分析.结果 EST 1次取石成功30例;1次取出部分结石4例,经行内镜下鼻胆引流,5 d后再次取石成功;成功率为91.9%.2例因结石大,碎石失败后行ERBD,6个月后结石变小,取出胆管结石;1例因乳头旁巨大憩室插胆管未成功而致取石失败.37例患者中并发出血1例（2.7%）,无肠穿孔、胰腺炎等并发症发生.结论 内镜行EST及ERBD治疗90岁及以上老年人胆总管结石安全、有效,具有创伤小、并发症少、操作灵活简便等优点.

Objective To evaluate the effect and safety of stone extraction via endoscopic retrograde cholangiopanereatography （ERCP） and endoscopic sphincterotomy （EST） in elderly cases over 90 years old with gallstones in common bile duct （CBD）. Methods Retrospective clinical data analysis was performed in 37 elderly cases treated by endoscopic stone extraction via ERC and EST. Results The gallstones of 30 cases were successfully extracted with only one trying. The multiple stones of another 4 cases were not totally extracted, they underwent endoscopic naso biliary drainage （ENBD） for 5 days, and then the stones were successfully extracted. The successful rate of stone extraction was 91.9% （34/37）. Giant stones in 2 eases were minimized and extracted 6 months later with help of endoscopic retrograde biliary drainage （ERBD）. In one case stone extraction failed, because of huge diverticulum. Bleeding complication during operation was observed in one case （2.7~）. Duodenal perforation and acute panereatitis were not documented in this group. Conclusions EST and ERBD are minor invasive, effective, safe and practical for stones extraction in elderly patients over 90 years old with gallstones in CBD.