体外冲击波碎石联合经内镜逆行胰胆管造影术治疗高龄困难胆总管结石的临床分析

Extracorpareal shock wave lithotripsy combined with endoscopic retrograde eholangiopanereatography for difficult common bile duct stones in elderly patients

目的探讨体外冲击波碎石(extracorporeal shock wave lithotripsy,ESWL)联合经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)治疗高龄困难胆总管结石的疗效及安全性。方法回顾性分析2016年11月-2020年1月在浙江大学医学院附属杭州市第一人民医院通过ESWL联合ERCP治疗的87例高龄(70~93岁)困难胆总管结石患者的临床资料,分析碎石成功率、结石取尽率和并发症发生情况。结果 87例患者共行189个疗程ESWL,平均碎石(2.51±0.78)个疗程。碎石成功82例(94.25%),其中完全碎石54例(62.07%),部分碎石28例(32.18%),未完成碎石5例(5.75%)。共84例(96.55%)ERCP取尽结石,3例(3.45%)未取尽结石,予取出部分结石后留置胆道支架。术后发生轻微并发症9例(10.34%),其中胆管炎2例(2.30%)、胰腺炎1例(1.15%)、高淀粉酶血症3例(3.45%)、一过性鼻胆管淡血性胆汁3例(3.45%)。结论 ESWL联合ERCP治疗高龄患者的困难胆总管结石安全有效。

Objective To study the efficacy and safety of extracorpareal shock wave lithotripsy(ESWL)combined with endoscopic retrograde cholangiopanereatography(ERCP)for difficult common bile duct(CBD)stones in elderly patients.Methods Data of 87 elderly patients(aged 70-93)diagnosed as having difficult CBD stones who were treated with ESWL combined with ERCP in the Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine from November 2016 to January 2020 were retrospectively analyzed.The lithotripsy success rate,complete removal rate and complic ations were analyzed.Results All 87 patients received a total of 189 procedures of ESWL,with an average of 2.51±0.78 procedures.The lithotripsy success rate of CBD stones was 94.25%(82 cases),including 54(62.07%)of complete lithotripsy and 28(32.18%)of partial lithotripsy.Incomplete lithotripsy was found in 5(5.75%)patients.Difficult CBD stones were completely removed in 84 patients(96.55%)via ERCP,and parially removed in 3 patients(3.45%)who were placed with biliary stents.Nine patients(10.34%)had minor complications,including 2 cases(2.30%)of cholangitis,1 case(1.15%)of pancreatitis,3 cases(3.45%)of hyperamylasemia,and 3 cases(3.45%)of transient hemobilia.Conclusion ESWL combined with ERCP is safe and efective for ifcult CBD stones in elderly patients.