【作者】 楼颂梅； 张筱凤； 张啸；

【Author】 LOU song-mei;zhang xiao-feng;ZHANG xiao;Department of gastroenterology,The First People’s Hospital of HangZhou;

【机构】 Department of gastroenterology,The First People’s Hospital of HangZhou；

【摘要】 目的探讨内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)治疗80岁以上老年人合并急性重症胆管炎的效果及安全性。方法对本院2001年8月至2014年10月间收治的80岁以上老年人合并急性重症胆管炎经ERCP治疗的415例患者的临床资料进行回顾性分析。结果415例患者中,病因为胆总管结石389例,胆道恶性肿瘤26例。26例胆道恶性肿瘤并发ACST患者,均先行ENBD引流和活检,待病情稳定后,再行胆道内支架置入术或外科手术治疗。389例胆总管结石合并ACST患者中,321例因病情危重或术中生命体征不平稳,先行ENBD减压引流,待病情平稳后再行EST取石;余68例一期取石成功,术毕放置ENBD引流。除5例出现ERCP术后并发症,其余患者内镜治疗后24-72小时黄疸指数、白细胞总数、体温以及有休克、精神症状的患者例数,均比治疗前有明显下降,急性胆管炎症状得到有效控制。结论对80岁以上高龄老年入合并重症胆管炎患者,ERCP术是一种安全、有效的治疗方法,能有效降低传统手术所特有的风险及并发症,可考虑作为治疗的首选方案。更多还原

【Abstract】 Objective To explore the therapeutic results and safety of endoscopic retrograde cholangiopancreatography in the management of acute cholangitis of severe type(ACST) during patients older than eighty.Methods The clinic data of 415 patients older than eighty with ACST who underwent ERCP during the period from August 2001 to October 2014 were reviewed.Results The causes of 415 patients with ACST were common bile duct(CBD) stones in 389 and biliary tract neoplasms in 26.26 cases with biliary tract neoplasms underwent endoscopic nasobiliary drainage(ENBD) to correct critical situation.After stabilization,surgical treatment or stent placement was performed.321 of 389 with CBD stones underwent ENBD in critical phase and endoscopic sphincterotomy(EST) plus stone removal for subsequent treatment after stabilization.68 of 321 with CBD stones underwent endoscopic sphincterotomy(EST) to remove stones.Procedure related complications were found in 5 patients.At 24 and 72 hours post-operation,a reduction in white blood cell count,serum total bilirubin,body temperature,and rate of patients with shock and mental symptoms was achieved in other 101 patients.Conclusion For patients older than eighty with ACST,ERCP is a safe and effective procedure.更多还原