ERCP胆道支架治疗高龄良性梗阻性黄疸的价值

The effect of biliary stent implantation by endoscopic retrograde imaging on the treatment of elderly benign obstructive jaundice

[目的]探讨内镜逆行性胰胆管造影(ERCP)胆道支架置入治疗高龄良性梗阻性黄疸的价值。[方法]选取高龄(年龄75~99岁)良性梗阻性黄疸患者52例,排除ERCP禁忌证后放置胆道支架置入引流。观察住院期间患者症状缓解情况、黄疸指数恢复情况,术后胰腺炎、胆管炎、穿孔等并发症发生情况。[结果]52例患者均成功放置胆道支架引流后均好转出院。24~48h腹部症状基本缓解,术后1~2周黄疸指数基本恢复正常。术后2例(3.85%)出现轻度胰腺炎,对症治疗后好转。3例(5.77%)出现高淀粉酶血症未作特殊处理。术后3例(5.77%)出现基础合并症加重,其中1例出现心房颤动再发,2例出现COPD加重。术后住院期间无胆管炎发作,术后随访3个月中有3例(5.77%)出现胆管炎再发,给以抗感染治疗后好转。[结论]ERCP胆道支架治疗高龄良性梗阻性黄疸安全有效,并发症发生率低,值得临床推广。

[Objective]To investigate the effect of biliary stent implantation by endoscopic retrograde imaging（ERCP） on the treatment of elderly benign obstructive jaundice, l-Methods]Fifty-two elderly patients（age from 75 to 99）with benign obstructive jaundice hospitalized in Suzhou Hospital affiliated to Nanjing Medical University from January 2013 to June 2016 were treated with biliary stent drainage successfully by ERCP without contraindications. Their clinical information was collected. The change of clinical symptoms,jaundice index and the incidence of postoperative complications such as pancreatitis, cholangitis and perforation were observed. [Results]All abdominal symptoms were relieved 24--48 h after ERCP stent implantation and jaundice index returned to normal 1--2 weeks after ERCP. Postoperative mild pancreatitis happened in 2 cases（3.85 %）and relieved after symptomatic treatment. Hyperamylasemia present in 3 cases （5.77%） without special treatment. And 3 cases（5.77%）with underlying diseases aggravated,including 1 case of atrial fibrillation recurrence and 2 cases of COPD aggravation. Cholangitis recurred in 3 cases （5.77 %）during 3 months of follow-up period and relieved after anti-infection treatment. [Conclusion]Biliary stent implantation by ERCP is safe and effective to treat elderly benign obstructive jaundice with low incidence of complications and worthy of clinical application.