内镜治疗老年总胆管结石30例体会

Endoscopic stone removal for common bile duct stones in 30 eldly people

目的 探讨内窥镜治疗老年总胆管结石的安全性和有效性。方法 对我院普外科收治的 3 0例 70岁以上的老年总胆管结石患者进行回顾性分析 ,所有患者均经B超或螺旋CT明确诊断并接受内镜治疗 ,治疗方法包括逆行胰胆管造影 (endoscopicretrogradecholangiopancreatography,ERCP) ,鼻胆管引流 (endoscopicnasobiliarydrainage ,EN BD) ,乳头括约肌切开 (endoscopicsphincterotomy,EST)和取石术 ,碎石术。测定患者内镜治疗前后的生化指标变化。结果 3 0例老年总胆管结石患者行ERCP检查 ,成功率 10 0 % ;2 8例行EST ,总胆管结石直径 <1.0cm者成功率10 0 % ,结石直径 1.0～ 1.5cm者成功率 86% ,结石直径≥ 1.5cm者需进行机械碎石取石 ,成功率 75 % ;另有 2例患者植入塑料支架作长期引流。 1例患者发生与内镜有关的并发症 ,死亡 1例。 3 0例患者治疗后各项生化指标较治疗前均有明显改善 (P <0 .0 0 1)。结论 内镜治疗老年总胆管结石成功率高 ,避免了手术创伤 ,安全性好 ,缩短住院时间 。

Objective: To investigate the endoscopic therapy on common bile duct stones of eldly patients.Methods: A group of 30 cases diagnosed by ultrasonography and helical computer tomography were involved in this study. All patients underwent endoscopic therapy including ERCP,ENBD,EST and mechanical lithotripsy. To detect the quantity of biochemical examination,and to compare the incidence between pre treatment and posttreatment of all patients.Results: 30 eldly patients with stones in common bile duct succeeded in ERCP. 28 cases received EST. Stones whose diameters <1.0cm were removed in all cases (100%), stones whose diameters 1.0～1.5cm were removed in 6 cases (86%), stones whose diameters ≥1.5cm were removed in 3 cases (75%). In 2 cases,endoscopic insertion of biliary endoprosthesis was done. The quantity of biochemical examination by posttreatment was ameliorated with that by pre treatment of all cases (P<0.001).Conclusion: Endoscopic therapy was regarded as the first choice of common bile duct stones in Eldly patients.