75岁以上老年患者治疗性内镜下逆行胰胆管造影术(ERCP)的临床应用

The clinical application of therapeutic endoscopic retrograde cholangiopancreatography(ERCP) in senile patients

目的 评价治疗性ERCP在75岁以上老年患者(≥75岁)中的应用价值;探讨高龄患者围手术期及并发症的处 理。方法对所有患者先行积极的术前准备,有心肺系统疾病者予以有效的治疗。在完成ERCP检查后,根据病情决定治疗 方案。结果 51例患者共完成治疗49例次,成功率96.08％。其中各部位恶性肿瘤22例,胆道系统结石19例,胆囊术后综合 征5例,Oddi氏括约肌功能障碍3例。进行乳头括约肌切开(EST)加取石13例,单纯EST治疗胆囊术后综合症或SOD 8例。 内支架植入术(ERBD)12例。鼻胆管引流术(DNBD)16例。本组无严重的并发症及死亡发生。结论 经过积极的术前准备和 仔细、周到的术中监护及操作,治疗性ERCP对高龄患者是安全和有效的。

Objective To evaluate the value of therapeutic ERCP and to study the handling of perioperative period and the complication in senile panents(≥75 years) . Methods Complete preparation should be carried out before procedure for all patients,and the current cir-culative or respiratory system diseases should be treated effectively.The plans of treatment were determined according to patients' condition after therapeutic ERCP. Results Therapeutic ERCPs were finished in 49 out of 51 patients and successful rate was 96.08% . Of those, 22 had biliary or pancreatic malignant tumor, 19 had cholelith,5 had the post-cholecystectomy syndrome,and 3 had sphincter of Oddi dysfunction(SOD) . Following procedure had been performed. 13 patients were underwent endoscopic sphincterotomy(EST) and fetching out cholelith.8 simple EST for post-cholecystectomy syndrome or SOD,12 endocopic retrograde biliary drainage(ERBD),and 16 endoscopic nasobiliary drainage(ENBD) were done.There was not any severe complication or death in this series.Conclusions The therapeutic ERCP is safe and effective to senile patients if active perparation before operation and careful monitoring during operation have been carried out.