中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2010年
10期
823-825
,共3页
胆管炎%危重病%胰胆管造影术,内窥镜逆行
膽管炎%危重病%胰膽管造影術,內窺鏡逆行
담관염%위중병%이담관조영술,내규경역행
Cholangitis%Criticalillness%Cholangiopancreatography,endoscopic retrograde
目的 探讨内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)治疗80岁及以上老年人急性重症胆管炎(ASC)的效果及安全性.方法 对80岁及以上老年ASC经ERCP治疗的106例患者的临床资料进行回顾性分析.结果 106例患者中,病因为胆总管结石95例,胆道恶性肿瘤11例.11例胆道恶性肿瘤并发ASC患者,均先行十二指肠镜鼻胆管引流术(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.95例胆总管结石合并ASC患者中,61例因病情危重或术中生命体征不平稳,先行ENBD减压引流,待病情平稳后再行内镜下乳头切开术(EST)取石;余34例一期取石成功,术毕行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 h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岁及以上老年ASC患者,ERCP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.
目的 探討內鏡下逆行胰膽管造影術(endoscopic retrograde cholangiopancreatography,ERCP)治療80歲及以上老年人急性重癥膽管炎(ASC)的效果及安全性.方法 對80歲及以上老年ASC經ERCP治療的106例患者的臨床資料進行迴顧性分析.結果 106例患者中,病因為膽總管結石95例,膽道噁性腫瘤11例.11例膽道噁性腫瘤併髮ASC患者,均先行十二指腸鏡鼻膽管引流術(ENBD)引流和活檢,待病情穩定後,再行膽道內支架置入術或外科手術治療.95例膽總管結石閤併ASC患者中,61例因病情危重或術中生命體徵不平穩,先行ENBD減壓引流,待病情平穩後再行內鏡下乳頭切開術(EST)取石;餘34例一期取石成功,術畢行ENBD引流.除5例齣現ERCP術後併髮癥,其餘患者內鏡治療後24～72 h黃疸指數、白細胞總數、體溫以及有休剋、精神癥狀的患者例數,均比治療前有明顯下降,急性膽管炎癥狀得到有效控製.結論 對80歲及以上老年ASC患者,ERCP是一種安全、有效的治療方法,能有效降低傳統手術所特有的風險及併髮癥,可攷慮作為治療的首選方案.
목적 탐토내경하역행이담관조영술(endoscopic retrograde cholangiopancreatography,ERCP)치료80세급이상노년인급성중증담관염(ASC)적효과급안전성.방법 대80세급이상노년ASC경ERCP치료적106례환자적림상자료진행회고성분석.결과 106례환자중,병인위담총관결석95례,담도악성종류11례.11례담도악성종류병발ASC환자,균선행십이지장경비담관인류술(ENBD)인류화활검,대병정은정후,재행담도내지가치입술혹외과수술치료.95례담총관결석합병ASC환자중,61례인병정위중혹술중생명체정불평은,선행ENBD감압인류,대병정평은후재행내경하유두절개술(EST)취석;여34례일기취석성공,술필행ENBD인류.제5례출현ERCP술후병발증,기여환자내경치료후24～72 h황달지수、백세포총수、체온이급유휴극、정신증상적환자례수,균비치료전유명현하강,급성담관염증상득도유효공제.결론 대80세급이상노년ASC환자,ERCP시일충안전、유효적치료방법,능유효강저전통수술소특유적풍험급병발증,가고필작위치료적수선방안.
Objective To explore the therapeutic effect and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the management of acute severe cholangitis (ASC) in patients older than eighty. Methods The clinical data of 106 patients aged 80 years and over with ASC who underwent ERCP were reviewed. Results Among 106 cases, there were 95 patients with common bile duct (CBD) stones, and 11 patients with biliary tract neoplasms. The 11 cases with biliary tract neoplasms underwent endoscopic nasobiliary drainage (ENBD) to correct critical situation. After stabilization, surgical treatment or stent placement was performed. The 61 of 95 cases with CBD stones underwent ENBD in critical phase and endoscopic sphincterotomy (EST) plus stone removal for subsequent treatment after stabilization. The 34 of 95 cases with CBD stones underwent EST to remove stones. Procedure-related complications were found in 5 patients. At 24 and 72 hours postoperation, the values of white blood cell count, serum total bilirubin, body temperature, and occurrence rate of patients with shock and mental symptoms were decreased in the other 101 patients.Conclusions For patients aged 80 years and over with ASC, ERCP is a safe and effective procedure.
