高龄胆总管结石患者内镜逆行胰胆管造影治疗的临床价值及安全性

Clinical value of endoscopic retrograde cholangiopancreaphy in elderly patients with common bile duct calculi and its safety

目的探讨内镜逆行胰胆管造影(ERCP)治疗高龄胆总管结石患者的临床价值及安全性。方法收集444例行ERCP治疗的胆总管结石患者的临床资料,根据年龄分组,其中126例年龄≥70岁者为高龄组,318例年龄<70岁者为非高龄组,分析患者临床疗效及并发症发生情况。结果高龄组1、2次取石成功率分别为78.6%、88.1%,手术时间、术中出血量、结石最大直径、取出结石数量分别为(58.23±14.59)min、(23.04±14.38)ml、(1.39±0.28)cm、(2.38±0.11)个;非高龄组1、2次取石成功率分别为84.0%、91.5%,手术时间、术中出血量、结石最大直径、取出结石数量分别为(54.58±13.87)min、(20.90±14.51)ml、(1.41±0.25)cm、(2.34±0.13)个,两组手术时间、术中出血量、结石最大直径、取出结石数量、1次与2次取石成功率比较差异无统计学意义(P>0.05)。高龄组术后并发症发生率为28.6%,其中胰腺炎、高淀粉酶血症、胆管炎发生率分别为7.1%、16.7%、4.8%;非高龄组术后并发症发生率为20.8%,其中胰腺炎、高淀粉酶血症、胆管炎发生率分别为5.7%、11.3%、3.8%,两组并发症发生率比较差异无统计学意义(P>0.05)。结论高龄胆总管结石患者行ERCP治疗取石成功率高、并发症发生率低,是一种安全有效的治疗方法。

Objective To investigate the clinical value of endoscopic retrograde cholangiopancreaphy（ ERCP） in elderly patients with common bile duct calculi and its safety. Methods A total of 444 patients with common bile duct calculi undergoing ERCP were divided into elderly group（ ≥70 years old,n = 126） and non-elderly group（ under 70 years old,n = 318）. Their clinical curative effect and complications were analyzed. Results One time and two times stone clearance rates were 78. 6% and 88. 1%in the elderly group,and the other parameters were listed as follow： operation time（ 58. 23 ± 14. 59） min,intraoperative blood loss（ 23. 04 ± 14. 38） ml,maximal stone diameter（ 1. 39 ± 0. 28） cm and removed stone number（ 2. 38 ± 0. 11）. In the non-elderly group,the counterparts were83. 4% and 91. 5%,（ 54. 58 ± 13. 87） min,（ 20. 90 ± 14. 51） ml,（ 1. 41 ± 0. 25） cm,and（ 2. 34 ±0. 13）,respectively. There were no significant differences in the above parameters（ P〈0. 05）. The incidence of postoperative complications of the elderly group was 28. 57%,of which that of pancreatitis,high blood amylase and cholangitis accounted for 7. 1%,16. 7% and 4. 8% respectively,and the counterparts of non-elderly group were 20. 8%,5. 7%,11. 3% and 3. 8% respectively.There were no statistically significant differences in postoperative complications between the two groups,either（ P〉0. 05）.Conclusion Lithotomy via ERCP is high at success rate and low at complication rate in elderly patients with common bile duct calculi,and it is an effective and safe therapeutic approach.