ERCP治疗老年胆总管结石150例临床分析

Clinical Analysis on ERCP for Elderly Patients with Choledocholithiasis in 150 Cases

目的分析ERCP技术在老年胆总管结石患者中的临床应用及疗效。方法回顾性分析内蒙古包钢医院2014年1月至2015年10月150例（≥70岁）老年胆总管结石患者行ERCP治疗的临床疗效。结果 150例胆总管结石患者插管成功149例（99.33%）,1例患者为胃大部切除术后,乳头位置变异插管失败转手术治疗。146例患者行ERCP＋EST（乳头肌切开术）,后行鼻胆管引流术（ENBD）,引流3~4 d后造影证实结石取净拔除引流管,3例患者因结石大于2.0 cm,放置支架,3个月后取石。术后并发症5例（3.33%）,其中急性胰腺炎3例为轻度,胆道感染2例,给予对症治疗,5 d后痊愈。出现一过性血淀粉酶升高20例（13.3%）,2 d后恢复正常。ERCP治疗后患者的肝功能及感染状况均有好转。结论 ERCP＋EST治疗老年胆总管结石安全性高,疗效显著,恢复快,并发症低。

Objective To study the clinical application and curative effect of the ERCP technology in elderly patients. Methods A retrospective analysis of Bao Gang Hospital of Inner Mongolia from January 2014 to October2015 for 150 patients（ over 70 years old）,elder patients undergo ERCP treatment with clinical effectiveness. Results Patients with choledocholithiasis were successful in 149 cases（ 99. 33%）,One patient with the gastritic operation and papillary position poor by intubation failure was changed over to operation treatment. After ERCP,Patients were performed endoscopic nasobiliary drainage（ ENBD）,Pull out the drainage tube of（ 146 /150） of the patients after stones disappeared which was proved by angiography for 3- 4days. Three cases were performed after three months with the 2. 0 cm stone. Postoperative complications occurred in five cases（ 3. 33%） including 3 cases of mild acute pancreatitis and 2 cases of infection of billary tract,and patients were cured after 5 days of corresponding treatment. Transient increase of serum amylase occurred in 20 cases,and returned to normal without any treatment after 2 days. Liver function and infection of patients after ERCP treatment was on the mend. Conclusion The results showed that ERCP were high safety and lower complications by elderly patients with choledochlithiasis,and were of obvious crative effect and recovery.