老年胆胰疾病治疗性逆行胰胆管造影临床分析

Clinical analysis of ERCP in aged patients with biliary tract and pancreatic diseases

目的探讨治疗性逆行胰胆管造影（ERCP）在老年胰胆疾病中的应用。方法回顾分析我院2009年1月-2014年12月82例≥75岁老年胆胰疾病患者治疗性ERCP的结果。结果82例患者插管成功78例，成功率为95．1％，其中胆总管结石59例（伴化脓性胆管炎11例，胆源性胰腺炎8例），胆总管良性狭窄3例，胆管癌5例（伴化脓性胆管炎2例），胰腺癌4例，壶腹部癌5例，胆总管结石合并肿瘤2例。胆总管结石行十二指肠乳头括约肌切开56例（其中预切开4例），十二指肠乳头括约肌扩张3例。一次完成取石45例，二次完成取石7例，放置塑料支架引流1例，伴化脓性胆管炎或胆源性胰腺炎先放置鼻胆管引流择期再取石6例；胆管梗阻患者放置塑料支架19例。术后发生并发症6例（7．7％），其中胰腺炎3例，消化道出血2例，胆管感染1例。取石成功后因肝肾功能衰竭死亡1例。结论老年胆胰疾病患者采用治疗性ERCP，术前充分的病情评估和准备，术中选择恰当的手术方式，缩短操作时间，是一种安全、有效、微创的治疗方法。

Objective To investigate the clinical effect of ERCP for the aged patients with biliary and pancreatic diseases. Methods Retrospective analysis was carried out of the 82 patients （≥75yeas old） who received ERCP from Jan. 2009 to Dec. 2014 in our hospital. Results 78 out of 82 patients had been successfully intubated ,and the success rate was calculated by 95.1%. Among the 78 patients,59 cases were diagnosed as common bile duct calculus, （ 11 of which combined with suppurative cholangitis and 8 with biliary pancreatitis） ,3 cases were common bile duct benign stricture,5 cases were cholangio- carcinoma（2 of which combined with suppurative cholangitis）,4 cases were pancreatic cancer, 5 cases were ampullary carcinoma and 2 cases were common bile duct calculus combined with tumor. Endoscopic sphincterotomy（EST） was performed on 56 patients with common bile duct calculus（4 of which were trea- ted with pre-incision）, and 3 cases were treated with EPBD （Endoscopic papillary balloon dilatation）. One-time stone clearance was in 45 cases, and secondary stone clearance in 7 cases, 1 case was implanted with plastic stent drainage,6 cases with common bile duct calculus combined with suppurative cholangitis or biliay pancreatitis were firstly placed with nose bile duct to drainage and received ERCP in another ap- propriate time. 19 patients with bile duct obstruction were placed plastic stent. Complications were oc- curred in 6 patients （7.7 % ） after ERCP, of which 3 patients suffered from pancreatitis,2 patients with gas- trointestinal bleeding, and 1 patient with infection of biliary tract. 1 patient with bile duct stones which has been successfully removed died from liver and kidney function failure. Conclusion It is necessary to e- valuate the patient conditions and make the preparation well before operation,to choose the appropriate op- eration method ,to shorten the operation time and reduce the risk of complication , and ERCP is a safe, simple, effective and minimally invasive treatment for the aged patients with biliary and pancreatic diseases.