ERCP/EST治疗80岁以上高龄胆总管结石患者的安全性及疗效分析

Analysis of the safety and efficacy of ERCP/EST in the treatment of common bile duct stones in patients over 80 years old

目的探讨经内镜逆行性胰胆管造影/乳头括约肌切开取石术(ERCP/EST)治疗80岁以上高龄胆总管结石患者的临床疗效。方法回顾性分析我院肝胆外科2016年1月~2019年12月明确诊断为胆总管结石的高龄(≥80岁)患者的临床资料,包括胆总管结石最大直径、术后并发症发生情况(胰腺炎、高淀粉酶血症、胆管炎、发热、十二指肠穿孔)、住院时间、住院总费用及手术前后相关指标。结果共有56例患者纳入研究,其中胆总管结石平均最大直径(1.14±0.42)cm,平均住院时间(9.68±4.80)d,平均住院总费用(25380.79±6622.17)元。术前谷氨酰转移酶(GGT)(466.79±397.29)U/L、凝血酶原时间(PT)(12.97±2.00)s、部分凝血活酶时间(APTT)(32.58±6.69)s;术后血清淀粉酶(172.60±239.69)U/L。术后总胆红素(TBIL)[(55.31±47.40)μmol/L vs.(33.93±41.52)μmol/L]、直接胆红素(DBIL)[36.30(52.33)μmol/L vs.14.35(15.95)μmol/L]、丙氨酸氨基转移酶(ALT)[92.25(174.98)U/L vs.47.60(59.95)U/L]、天门冬氨酸氨基转移酶(AST)[74.45(154.48)U/L vs.32.25(58.55)U/L]较术前明显降低,差异有统计学意义(P<0.05)。术后出现高淀粉酶血症12例,胰腺炎1例,无其他并发症发生。结论ERCP/EST治疗80岁以上高龄胆总管结石患者安全、有效,患者术后TBIL、DBIL、ALT、AST较术前明显降低,可作为高龄胆总管结石患者的治疗方式。

Objective To investigate the clinical efficacy of endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy(ERCP/EST)in the treatment of elderly patients with common bile duct stones over 80 years old.Methods The clinical data of elderly patients(≥80 years old)diagnosed with common bile duct stones in hepatobiliary surgery of our hospital from January 2016 to December 2019 were retrospectively analyzed,including the maximum diameter of common bile duct stones,postoperative complications(pancreatitis,hyperamylasemia,cholangitis,fever,duodenal perforation),hospitalization time,total hospitalization cost and related indicators before and after surgery.Results A total of 56 patients were included in the study.The average maximum diameter of common bile duct stones was(1.14±0.42)cm,the average hospitalization time was(9.68±4.80)d,and the average total hospitalization cost was(25380.79±6622.17)yuan.The preoperative levels of gamma-glutamyl transferase(GGT),prothrombin time(PT)and activated partial thromboplastin time(APTT)were(466.79±397.29)U/L,(12.97±2.00)s and(32.58±6.69)s,respectively.Postoperative serum amylase was(172.60±239.69)U/L.Postoperative total bilirubin(TBIL)[(55.31±47.40)μmol/L vs.(33.93±41.52)μmol/L]direct bilirubin(DBIL)[36.30(52.33)μmol/L vs.14.35(15.95)μmol/L],alanine aminotransferase(ALT)[92.25(174.98)U/L vs.47.60(59.95)U/L],aspartate aminotransferase(AST)[74.45(154.48)U/L vs.32.25(58.55)U/L]were significantly lower than those before operation.The difference was statistically significant(P<0.05).Postoperative hyperamylasemia occurred in 12 cases,pancreatitis in 1 case,and no other complications occurred.Conclusion ERCP/EST is safe and effective in the treatment of elderly patients with common bile duct stones over 80 years old.The levels of TBIL,DBIL,ALT and AST after operation are significantly lower than those before operation,which can be used as a treatment for elderly patients with common bile duct stones.