内镜治疗90岁及以上老年人胆总管结石患者的临床护理研究

Research of the clinical nursing of endoscopic treatment on 90 years old and older patients with choledocholithiasis

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、安全性及护理。方法对32例90岁及以上老年人患者完善术前准备，在密切监护下行EST及ERBD治疗胆总管结石的临床资料进行回顾性分析。结果EST1次取石成功27例；1次取出部分结石3例，经行内镜下鼻胆管引流，5d后再次取石成功；成功率为93．8％。1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管未成功而致取石失败。32例患者中并发出血1例（3．1％），未发生肠穿孔、胰腺炎等并发症和死亡。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，护士完善的术前准备、准确迅速的术中配合和监护，精心的术后护理是治疗成功的重要条件。

Objective To explore the curative effect, safety and nursing of endoscopic sphincterotomy （EST） and endoscopic retrograde biliary drainage （ERBD） on 90 years old and older patients with choledocholithiasis . Methods A total of 32 patients aged 90 years and older were improved the preoperative preparation, EST and ERBD were used to treat choledocholithiasis. The clinical data were analyzed. Results There were 27 successful case by EST; 3 cases took out some of the calculus, successfully took out the calculus 5 days later, the success rate was 93.8%. 1 case was treated with ERBD after failed broken calculus because of the big calculus The calculus became little 6 month later and successfully taken out the calculus ; 1 case failed because of the nipple into huge diverticula bile duct without success. There was 1 case concurrent bleeding out of 32 patients （3.1%） . There was no enterobrosis, pancreatitis complication and death. Conclusions EST and ERBD treating patients aged 90 years is safety and effective and it has the advantage of small, less traumatic complications, flexible operation simple. The impeccable preoperative preparation, accurate rapid decompression of the coordination and monitoring, and careful postoperative nursing are the important conditions of successful treatment.