内镜下逆行胰胆管造影术治疗老年胆总管巨大结石40例

摘要

目的 探讨内镜下逆行胰胆管造影术(ERCP)治疗老年胆总管巨大结石的可行性及安全性.方法 40例老年胆总管巨大结石患者完善术前准备,密切监护下经十二指肠镜先行ERCP,发现胆总管结石后行内镜下十二指肠乳头括约肌切开(EST)和机械碎石(EML)取石,视具体情况留置鼻胆管引流及支架置人引流.结果 40例患者37例取石获得成功,成功率92.5％；其中10例经过二次取石.所有患者腹痛症状明显改善,皮肤巩膜黄染迅速消褪,发热患者48 h内体温趋于正常.术后并发轻型胰腺炎4例,乳头肌切口创面轻度渗血2例,均经内科保守治疗痊愈,未发生肠穿孔、胆道撕脱等严重并发症和死亡.结论 ERCP治疗老年胆总管巨大结石是一种安全、有效的治疗方法,应考虑作为治疗的首选方案.%Objective To study the feasibility and outcome of preoperative endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients undergoing endoscopic extracton of large common bile duct stones. Methods Forty elderly patients (age range: 70-90 years old) with large ( >20 mm) common bile duct stones underwent preoperative ERCP to visualize the stones and assess the difficulty of extraction. Endoscopic sphincterotomy (EST) and endoscopic mechanical lithotripsy (EML) were used on all patients to extract the stones. Endoscopic nasobiliary drainage or endoscopic retrograde biliary drainage (ERBD) was applied according to the specific circumstances of each patient. Postoperative therapy included antibiotics and antacids. Measurements of blood amylase and trypsin inhibitor was measured to monitor patient recovery status. Results Bile stones were successfully extracted from 37 of the 40 cases, giving a success rate of 92. 5% . Nine of these 37 cases required a second operation to retrieve the stone basket or balloon ( n = 6) or to replace the original stent ( n = 3). Six patients developed postoperative complications ( pancreatitis, n = 4; delayed incision hemorrhage, n = 2) , but all were cured with standard medical therapies. None of the patients experienced severe complications, such as death, bowel perforation, or bowel tearing. Conclusion ERCP is safe and efficient for use with endoscopic surgical extraction of large common bile duct stones in elderly patients. ERCP is recommended for treatment of these patients.