高龄患者难取性胆总管巨大结石的手术选择及术后并发症分析

Analysis of operation selection and postoperative complications of elderly patients with refractory choledoch huge gallstone

目的 探讨高龄患者难取性胆总管巨大结石的手术选择,并对患者术后并发症进行分析.方法 难取性胆总管巨大结石高龄患者68例,依据入院顺序将患者分为研究组和对照组,每组34例,对照组行经内镜逆行性胰胆管造影术（ERCP）治疗,研究组行胆道塑料支架术治疗,对两组患者的术后临床效果及术后并发症情况进行观察比较.结果 研究组术后结石大小无变化者、结石消失者、胆总管结石有不同程度的缩小或成碎片状者、肝内外胆管扩张明显回缩者分别为1、7、18 、8例;对照组对应分别为6、1、10、7例;研究组术后临床效果显著优于对照组（P〈0.05）;研究组术后并发症发生率显著低于对照组（P〈0.05）.结论 胆道塑料支架术对难取性胆总管巨大结石高龄患者的治疗较ERCP具有更显著优势,是治疗高龄难取性胆总管巨大结石的一种疗效确切、安全可靠的手段.

Objective To investigate the operation selection of elderly patients with refractory choledoch huge gallstone, and analyze the postoperative complications.Methods Sixty-eight patients from March 2011 to October 2014 were enrolled in the study, the patients were divided into study group and control group according to the order of admission （with 34 cases in each group）, the control group received endoscopic retrograde cholangiopancreatography （ERCP） treatment, and the study group received biliary plastic stent, the postoperative clinical effect and postoperative complications in the two groups were observed and compared.Results There was one case of no change in postoperative size of stones, seven cases of gallstone dissolved, 18 cases of shrink in different degrees or changed into fragments in choledoch gallstone, 8 cases of obvious rebound of intrahepatic and extrahepatic bili duct eclasis in study group, corresponding cases of the control group were 6 cases, 1 case, 10 cases, 7 cases respectively;the postoperative clinical effect in study group was significantly higher than that in control group （P〈0.05）;the postoperative complications rate in study group was significantly lower than that in control group （P〈0.05）.Conclusions Effect of biliary plastic stent on elderly patients with refractory choledoch huge gallstone possess has outstanding advantage over ERCP, is effective, safe and reliable.