高龄患者进行治疗性逆行胆管造影的经验体会

目的评估在80岁以上高龄患者中经逆行胆管造影(ERCP)进行胆胰疾病治疗的疗效和安全性。方法回顾性分析该院自2005年12月—2011年12月经ERCP进行胆胰疾病治疗的80岁以上高龄患者的病历资料。结果 237例80岁以上高龄患者共进行了268例次治疗性ERCP。患者行ERCP治疗的原因有:胆管结石(53.2%)、恶性梗阻性黄疸(20.2%)、胆源性胰腺炎(10.5%)、急性化脓性胆管炎(9.7%)、良性胆管狭窄(3.4%)、其他(3.0%)。治疗性ERCP的成功率94.9%,其中14.6%为急诊ERCP。95.4%的胆管结石完全取净,4例患者因结石未能取出而置入塑料胆道支架,2例转外科手术治疗。23例患者因胆道恶性梗阻而置入金属胆道内支架。共置入塑料胆道支架34例,其中11例因支架堵塞而行支架置换术。12例患者未能完成治疗性ERCP。共183例(77.2%)患者伴乳头旁憩室。出现并发症6例(2.2%):胆管炎2例,胰腺炎1例,出血2例,穿孔1例,无死亡病例。结论对于患有胆胰疾病的高龄患者,治疗性ERCP是一种安全、有效的治疗方法。

Application of therapeutic ERCP in patients 80 years of age and older

Objective To evaluate the efficacy and the safety of therapeutic ERCP in patients 80 years of age and older with biliary and pancreatic diseases.Methods Patients with biliary and pancreatic diseases treated with therapeutic ERCP in our hospital from December 2005 to December 2011 were retrospectively reviewed.Results Two hundred and thirty seven patients underwent 268 therapeutic ERCP procedures.The indications included choledocholithiasis（53.2%）,malignant obstructive jaundice（20.2%）,biliary pancreatitis（10.5%）,acute suppurative cholangitis（9.7%）,benign biliary stricture（3.4%）and others（3.0%）.The success rate of therapeutic ERCP was 94.9% and 14.6% of all procedures were emergent.Bile duct stones were completely cleared in 95.4% of patients with choledocholithiasis.Four patients underwent ERBD and two patients were referred for surgical intervention due to unsuccessful clearance of bile duct stone.Metal biliary stents were inserted in 23 patients with malignant obstructive jaundice.Plastic biliary stents were inserted in 34 patients,of which 11 patients underwent stent replacement because of stent occlustion.Unssuccessful ERCP procedures occurred in 12 cases.There were 183（77.2%）patients with peripapillary diverticulum.Complications occurred in 6 patients including cholangitis（2 cases）,pancreatitis（1 case）,hemorrhage（2 cases）and perforation（1 case）and there was no death case in the group.Conclusion For patients 80 years of age and older with biliary and pancreatic diseases,therapeutic ERCP is an effective and safe treatment.