ERBD治疗老年胆总管结石的临床价值

ERBD in the Treatment of Bile Duct Stones of elderly patients

目的探讨ERBD治疗老年患者胆总管大结石、多发结石的临床应用价值。方法回顾分析68例行ERCP治疗的确诊为胆总管大结石或多发结石的老年患者,45例为放置支架组,ERCP术中放置单根或双根塑料胆管支架行胆管引流,3~4个月后再次行ERCP取石或更换支架治疗;23例为直接取石组,行乳头切开,直径为10~12mm的球囊扩张乳头后,碎石器网篮碎石,普通网篮、气囊取石。比较两组患者取石时间、取石成功率及术后并发症的发生情况。结果 68例患者支架组平均年龄为82.5±4.69岁,取石组平均年龄为84.9±4.48岁,支架组结石平均直径1.97±0.5cm,取石组结石平均直径为1.70±0.36cm,两组间无统计学差异。支架组ERBD术后发生胰腺炎2例(4.44%),取石组4例(17.4%)(P<0.05);支架组术后3 h、术后24 h血淀粉酶值分别为(230±162)U/L及(195±145)U/L,均低于取石组(328±215)U/L及(283±167)U/L(P<0.05)。支架组首次平均操作时间为(41±15)min,取石组平均取石时间为(83±25)min,较支架组明显延长(P<0.05)。支架组术中及术后严重并发症为0,取石组术中及术后严重并发症4例(2例并发迟发性出血、2例并发贲门撕裂)(P<0.05);支架组更换支架及取石平均次数为2.4次(2次33人,3次8人,4次2人,4次以上2人),取石组平均取石次数为1.26次(1次18人,2次4人,3次1人)。结论巨大或多发胆管结石老年患者首次行塑料支架放置胆管引流安全有效,较直接取石明显减少术后严重并发症的发生,其结石取出结果也较为满意。

Objective To explore the clinical value of ERBD in the treatment of choledocholithiasis in elderly patients. Meth- ods Retrospective analysis of 68 patients diagnosed with choledocholithiasis or multiple stones in elderly patients underwent ERCP treatment. Single or double plastic stents in bile duct placed to drainage in 45 cases. ERCP was applied 3 - 4 months later to remove stones or replace stents. In 23 cases stones were remove directly by cutting the bile papilla, expanding with balloon of 10 - 12mm, usage of mechanical lithotriptor and stone extractor. The operative time, the rate of stone extraction and the incidence of postoperative compli- cations were analysis in two groups. Results The mean age and the average diameter of stones in two groups was no significant differ- ence （ P 〉 0. 05 ）. The incidence of postoperative pancreatitis in stent group is 2, and 4 in lithotripsy group （ P 〈 0. 05 ）. The postop- erative amylase levels in 3 hour and 24 hour are （230±162） U/L and （ 195 ±145 ） U/L, （328 ±215 ） U/L and （283 ±167 ） U/L re- spectively （ P 〈 0.05 ）. In the stent group, the average operation time was （41 ± 15 ） min. lower than lithotripsyand group （ （ 83±25 ） rain P 〈0. 05 ）. No severe complication in the stent group and 4 cases in the lithotripsy group （2 cases with delayed hemorrhage and 2 cases with cardia laceration） （P 〈0.05）. The average ERCP in stent group was 2.4 and 1.26 times in two groups. Conclusion ERBD is safe, effective treatment in elderly patients with large or multiple choledocholithiasis with fewer complications.