CAJ | 학술논문

目的：分析内镜逆行性胰胆管造影( ERCP)合并内镜乳头括约肌切开术( EST)治疗老年胆总管结石的临床疗效并讨论其临床意义。方法回顾性分析老年胆总管结石患者256例,通过ERCP掌握患者结石特征,并经内镜乳头括约肌切开术(EST)进行取石治疗。结果256例胆管结石患者插管成功249例(97.27%),EST取石成功239例(93.36%),其中1次成功后取石199例(83.26%),2次成功40例(16.74%)。有7例患者(2.73%)因多发憩室,乳头位置不佳插管失败转手术治疗。 ERCP合并EST后行内镜下鼻胆管引流术(ENBD)64.44%(154/239),引流3~5 d后造影证实结石取净90.91%(140/154)拔除了引流管,14例(9.09%)残余结石行2次内镜取石。术后并发症15例(6.02%),包括急性胰腺炎9例,胆道感染6例,给予相应治疗1周后痊愈。出现一过性血淀粉酶升高39例未做特殊处理,3 d后恢复正常。结论老年胆总管结石行ERCP(或EST)耐受性好,疗效显著且恢复快,有条件医院可以推广应用。
목적：분석내경역행성이담관조영( ERCP)합병내경유두괄약기절개술( EST)치료노년담총관결석적림상료효병토론기림상의의。방법회고성분석노년담총관결석환자256례,통과ERCP장악환자결석특정,병경내경유두괄약기절개술(EST)진행취석치료。결과256례담관결석환자삽관성공249례(97.27%),EST취석성공239례(93.36%),기중1차성공후취석199례(83.26%),2차성공40례(16.74%)。유7례환자(2.73%)인다발게실,유두위치불가삽관실패전수술치료。 ERCP합병EST후행내경하비담관인류술(ENBD)64.44%(154/239),인류3~5 d후조영증실결석취정90.91%(140/154)발제료인류관,14례(9.09%)잔여결석행2차내경취석。술후병발증15례(6.02%),포괄급성이선염9례,담도감염6례,급여상응치료1주후전유。출현일과성혈정분매승고39례미주특수처리,3 d후회복정상。결론노년담총관결석행ERCP(혹EST)내수성호,료효현저차회복쾌,유조건의원가이추엄응용。
Objective Objective To analysis the clinical curative effect on elderly patients with choledocholithiasis by endoscopic retro-grade cholangiopancreatography ( ERCP) and endoscopic sphincterotomy ( EST) and discuss its clinical significance. Methods 256 patients with choledocholithiasis were collected for diagnosis and treatment by ERCP. The stone characteristics was mastered by ERCP and the pa-tients were treated with EST. Results Patients with choledocholithiasis were successful in 249 cases (97. 27%) for ERCP intubation and 239 cases (93. 36%) for stone remove. After EST,the stones were removed successfully at one time in 199 cases (83. 26%),2 times in 40 cases (16. 74%). 7 patients (2. 73%) with multiple diverticulum and papillary position poor by intubation failure were changed over to op-eration treatment. After ERCP,patients were performed endoscopic nasobiliary drainage (ENBD) 64. 44% (154/239). Pull out the drain-age tube of 90. 91% (140/154) of the patients after stones disappeared which was proved by angiography for 3~5 days. 14 cases (9. 09%) were performed second times to remove the stones due to the presence of residual stones. Postoperative complications occured in 15 cases (6. 02%) including 9 cases of acute pancreatitis and 6 cases of infection of biliary tract, and they were cured after 1 week of corresponding treatment. Transient increase of serum amylase occurred in 39 cases, and all of them recoveried after 3 days without special treatment. Con-clusion The results showed that ERCP ( or EST) were well tolerated by elderly patients with choledocholithiasis,and they were of obvious curative effect and quick recovery,which is worthy of promotion and application.