老年人胆管结石内镜下括约肌切开预防并发症及疗效分析

Endoscopic sphincter incision in treating bile duct stones and preventing complications in elderly patients

目的：分析内镜下括约肌切开术（ EST）在老年人胆管结石治疗中的疗效及常见并发症的预防。方法选择2011年1月至2014年2月因胆管结石行EST治疗156例患者，通过内镜逆行胰胆管造影（ERCP）诊疗，了解及掌握其操作流程、治疗方法及并发症的预防。结果本组患者均ERCP插管成功，操作取石，术后常规留置鼻胆引流管。近期（3 d内）并发症23例（14．7％），其中注入性胰腺炎8例（5．1％），胆道感染2例（1．2％），术后出血1例（0．6％），淀粉酶升高8例（5．1％），上腹胀痛、呕吐4例（2．5％）；远期（1～3个月）并发症18例（11．5％），其中周期胆道感染12例（7．6％），反复胰腺炎6例（3．8％）。术后1年随访36例患者（23．1％），其中18例（50．0％）再次出现胆管结石，考虑结石复发。结论老年人胆管结石行EST治疗优势，值得临床广泛推广。

Objective To analyze the efficacy of endoscopic sphincter incision （ EST ） in the treatment of elderly patients with bile duct stones and the prevention of common complications . Methods From January 2011 to February 2014, 156 patients with bile duct stones were treated by EST , and the purpose of this study was to understand the operation flow , treatment methods and prevention of complications . Results ERCP was successfully performed in this group of patients , in addition to lithotomy, postoperative routine indwelling of a nasal biliary drainage tube . Short-term （ 3 days ） complications occurred in 23 （ 14.7%） patients, in which 8 （ 5.1%） patients developed injected pancreatitis, 2（1.2%）patients developed biliary tract infection , 1（0.6%） patient developed postoperative bleeding, 8（5.1%） patients developed amylase, and 4（2.5%）patients developed abdominal pain and vomiting.The long-term complications （3 months） were discovered in 18 （11.5%） patients.Biliary tract infection was found in 12 （7.6%） patients, and recurrent pancreatitis in 6（3.8%）.Thirty-six （23.1%） patients were followed up after operation .Bile duct stones were found in 18 （50.0%） patients, and they were considered as recurrent stones . Conclusion EST is superior in the treatment of elderly patients with bile duct stones and is worth popularizing .