EPLBD在老年人胆总管困难结石治疗中的应用

Endoscopic Papillary Balloon Dilation for Difficult Bile Duct Stones Removal in Patients 60 Years Old or Younger

目的探讨内镜下乳头大球囊扩张术(EPLBD)在老年胆总管困难结石治疗中的有效性和安全性。方法 106例胆总管困难性结石(横径≥13mm或3个以上≥10mm)进行EPLBD取石术,按年龄分为A组(<60岁)和B组(≥60岁),观察两组合并慢性疾病和解剖畸形、手术成功率、并发症发生率和ERCP次数等指标。结果 B组有较多乳头旁憩室、高血压、高脂血症、心脑血管疾病/痴呆、呼吸系统疾病和心脏病,服用抗凝剂或抗血小板剂也更多(P<0.05)。两组取石成功率分别为88.1%(52/59)和89.4%(42/47),完全取石成功率均为100%,需要机械碎石分别为10.2%(6/59)和12.8%(6/47)。ERCP次数为1.24±0.68和1.17±0.53。并发症的发生率为6.8%(4/59)和2.1%(1/47),在治疗成功率、ERCP次数、并发症的发生率方面两组比较差异无统计学意义(P>0.05)。结论老年患者EPLBD取石安全、有效。

Objective To investigate whether endoscopic papillary large balloon dilation （EPLBD） can be safety and effectively per- formed in patients agcd≥60 years. Methods Lithotomy by EPLBD was conducted in 106 patients with bile duct stones ≥13ram in size or with three or more bile duct stones≥ 10mm. The patients were divided into group A（ 〈 60 years）and group B（ ≥60 years）. Procedure success rate, number of endoscopic retrograde cholangiopancreatography （ERCP） , and incidence of complications were examinedin both groups. Results Group B tended to include significantly more patients with peripapi]lary diverticulum, hypertension,hyperlipemia,eere- brovascular disease/dementia,respiratory disease/cardiac disease, and patients administered anticoagulant or antiplatelet agent （P 〈 0.05）. A, B two groups of lithotomy success rate was 88.1% （52/59） and 89.4% （42/47） , and eompletely removed the success rate is 100% , need mechanical lithotripsy respectively accounted for 10.2% （6/59） and 12.8% （6/47）. ERCP was 1.24±0.68 times and 1.17 ±0.53. The incidence of complications was 6.8% （4/59） and 2.1% （1/47） , and the statistical analysis had no significant differ- enee in treatment success rate, ERCP frequency, and incidence of complications. Conclusion EPLBD can be safely performed in elderly patients, the same as in younger patients.