CAJ | 학술논문

目的：探讨内镜下逆行胰胆管造影（ERCP）治疗老龄胆总管结石患者的临床疗效。方法回顾性总结医院2009年1月-2013年1月行 ERCP 治疗的﹥60岁胆总管结石患者，评价 ERCP 治疗老龄胆总管结石患者的安全性及有效性。结果967例老龄胆总管结石患者成功治疗957例，其中7例因心肺功能差或无法配合未实施 ER-CP，3例术中穿孔转外科手术治疗。首次插管成功率96.5％，手术成功率98.9％。结石1次取净864例（90％），2次取净结石48例（5％），﹥2次取净结石26例（2.7％），放置胆道支架22例（2.3％）。ERCP 后总胆红素（64.5±105.9）μmol/ L；术后直接胆红素（36.7±59.8）μmol/ L；术后谷丙转氨酶（61.8±71.2）U/ L；术后谷草转氨酶（50.3±61）U/ L。术后肝功明显好转（P ﹤0.05）。术后2h 血淀粉酶（113±161）U/ L，无统计学差异（P ﹥0.05），24h 血淀粉酶（126.9±219.9）U/ L，与术前相比有统计学差异（P ﹤0.05）。术后腹痛、寒战、发热、黄疸均有不同程度的减轻或消失。﹥60岁胆总管结石患者术后平均住院天数3~7d，与﹤60岁年龄相比无统计学意义（P ﹥0.05）。并发症36例，并发症发生率3.7％，其中急性胰腺炎11例，急性胆管炎12例，出血10例，穿孔3例，经对症治疗后均治愈出院，无1例死亡。结论 ERCP 治疗老龄胆总管结石临床疗效显著，对老龄患者是安全、有效的治疗方式。
목적：탐토내경하역행이담관조영（ERCP）치료노령담총관결석환자적림상료효。방법회고성총결의원2009년1월-2013년1월행 ERCP 치료적﹥60세담총관결석환자，평개 ERCP 치료노령담총관결석환자적안전성급유효성。결과967례노령담총관결석환자성공치료957례，기중7례인심폐공능차혹무법배합미실시 ER-CP，3례술중천공전외과수술치료。수차삽관성공솔96.5％，수술성공솔98.9％。결석1차취정864례（90％），2차취정결석48례（5％），﹥2차취정결석26례（2.7％），방치담도지가22례（2.3％）。ERCP 후총담홍소（64.5±105.9）μmol/ L；술후직접담홍소（36.7±59.8）μmol/ L；술후곡병전안매（61.8±71.2）U/ L；술후곡초전안매（50.3±61）U/ L。술후간공명현호전（P ﹤0.05）。술후2h 혈정분매（113±161）U/ L，무통계학차이（P ﹥0.05），24h 혈정분매（126.9±219.9）U/ L，여술전상비유통계학차이（P ﹤0.05）。술후복통、한전、발열、황달균유불동정도적감경혹소실。﹥60세담총관결석환자술후평균주원천수3~7d，여﹤60세년령상비무통계학의의（P ﹥0.05）。병발증36례，병발증발생솔3.7％，기중급성이선염11례，급성담관염12례，출혈10례，천공3례，경대증치료후균치유출원，무1례사망。결론 ERCP 치료노령담총관결석림상료효현저，대노령환자시안전、유효적치료방식。
Objective To investigate the effect of endoscopic retrograde cholangiopancreatography(ERCP)clinical efficacy in the treatment of elderly patients with choledocholithiasis. Methods 967 Cases who receive ERCP therapy from Jan-uary 2009 to January 2013 were studied retrospective ,evaluate the safety and efficacy of therapeutic ERCP in patients 60 years of age and older with Common bile duct calculi. Results 967 Cases of elderly patients with common bile duct stones treated successfully with 957 cases,Among them 7 cases because of poor cardiopulmonary function or unable to cope with the non im-plementation of ERCP,3 cases of intraoperative perforation of surgical operation treatment. for the first time,the success rate of intubation was 96. 5% ,the successful rate of operation was 98. 9% . The stones were removed completely one time in 864 cases (90% ),two times take net calculi in 48 cases(5% ),more than two times take net calculi in 26 cases(2. 7% ),22 cases were placed biliary stent(2. 3% ). Total bilirubin after ERCP:64. 5 ± 105. 9μmol/ l;postoperative bilirubin direct:36. 7 ± 59. 8μmol/ l;postoperative ALT:61. 8 ± 71. 2U/ L;postoperative aspartate aminotransferase:50. 3 ± 61U/ L;postoperative liver function improved significantly(P ﹤ 0. 05). Postoperative 2h blood amylase was 113 ± 161U/ L. showed no significant differ-ence(P ﹥ 0. 05),24h blood amylase was 126. 9 ± 219. 9U/ L,there was significant difference compared with before operation (P ﹤ 0. 05). Postoperative pain,chills,fever,jaundice have different degrees of ease or disappear. The average length of 60 years old of above of common bile duct stones in patients with postoperative days 3 ~ 7days,compared with the age below 60 years old with no statistical significance(P ﹥ 0. 05). Complications Occurred in 36 cases,the complication rate was 3. 7% ,in-cluding 11 cases of acute pancreatitis,12 cases of acute cholangitis,10 cases of bleeding,perforation in 3 cases,after symptom-atic treatment were cured and discharged,no deaths. Conclusion ERCP significant therapeutic effect in the treatment of com-mon bile duct stones of aging,in aging patients is safe,effective treatment.