Clinical effect of endoscopic retrograde cholangiopancreatography in 80 elderly patients with biliary pancreatitis
-
摘要: 目的探讨80岁以上胆源性胰腺炎患者内镜治疗的安全性和疗效。方法回顾性分析2006年1月-2013年10月成都军区总医院消化中心收治的80例大于80岁的胆源性胰腺炎患者资料,采用经内镜逆行胰胆管造影(ERCP)+十二指肠乳头括约肌切开术(EST)+鼻胆管引流(ENBD),或胆道塑料支架植入术治疗。结果 80例患者中,4例因镜下无法找到十二指肠大乳头开口而转为开腹手术,余76例均完成内镜治疗,成功率95%(76/80),其中2例死亡,病死率2.6%(2/76)。其中一次性完成ERCP+EST+ENBD治疗者69例,7例因较大铸型结石嵌顿无法碎石而行胆道塑料支架植入;1例因感染性休克死亡,1例因反复消化道出血死亡。结论内镜治疗高龄胆源性胰腺炎患者具有创伤小、恢复快、病死率低的优点,是一种安全有效的治疗方法。Abstract: Objective To investigate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) treatment in elderly patients with biliary pancreatitis.Methods A retrospective analysis was performed on 80 elderly patients (more than 80 years old) with biliary pancreatitis who were admitted to our center from January 2005 to December 2013.The patients were treated with a combination of ERCP, endoscopic sphincterotomy (EST) , and endoscopic nasal biliary drainage (ENBD) , or treated with plastic biliary stent implantation.Results ERCP treatment was successful in 76 (95%) of the 80 patients, while the other 4 patients were converted to open surgery because of failure to identify the major duodenal papilla endosopically.The mortality rate from ERCP treatment was 2.6% (2 /76) , with the causes of death being septic shock and repeated gastrointestinal bleeding, respectively.The first ERCP + EST + ENBD treatment was successfully performed in 69 of the 76 patients, while the other 7 patients were treated with plastic biliary stent implantation due to unremovable large cast stones.Conclusion ERCP treatment leads to small trauma, quick recovery, and low mortality in elderly patients with biliary pancreatitis, suggesting that it is a safe and effective therapy.
-
Key words:
- pancreatitis /
- surgical procedures, minimally invasive /
- treatment outcome
-
[1]NGUYEN GC, ROSENBERG M, CHONG RY, et al.Early cholecystectomy and ERCP are associated with reduced readmissions for acute biliary pancreatitis:a nationwide, population-based study[J].Gastrointest Endos, 2012, 75 (1) :47-55. [2]LI K, SU J, ZHANG ZY.The timing of endoscopic therapy of severe acute biliary pancreatitis[J].Chin J Pract Surg, 2005, 25 (6) :357-358. (in Chinese) 李珂, 苏杰, 张志勇.重症急性胆源性胰腺炎内镜治疗时机探讨[J].中国实用外科杂志, 2005, 25 (6) :357-358. [3]HU Q, TAO J, ZHU W, et al.Clinical feature and minimally invasive treatment for elderly patients with severe acute biliary pancreatitis[J].Shanghai Med J, 2013, 36 (9) :801-804. (in Chinese) 胡强, 陶健, 朱娓, 等.老年重症急性胆源性胰腺炎的临床特点与微创处理[J].上海医学, 2013, 36 (9) :801-804. [4]JIN JP, ZHANG B, LI CF, et al.Therapeutic ERCP in geriatric population with common bile-duct stones (report of 91 cases) [J].J Clin Hepatol, 2012, 28 (2) :105-107. (in Chinese) 金景鹏, 张斌, 李长锋, 等.治疗性经内镜逆行胰胆管造影在高龄人群胆总管结石中的应用 (附91例临床分析) [J].临床肝胆病杂志, 2012, 28 (2) :105-107. [5]ZHANG XP, ZHANG T, WANG MM, et al.Treatment of biliary pancreatitis with choledocholithiasis[J].J Hepatopancreatobiliary Surg, 2012, 24 (1) :65-66. (in Chinese) 张小平, 张涛, 汪茂鸣, 等.胆源性胰腺炎合并胆总管结石的临床治疗[J].肝胆胰外科杂志, 2012, 24 (1) :65-66. [6]CHEN J, LIU J, DENG DH, et al.Endoscopic retrograde cholangiopancreatography therapy of large common bile duct stones in 40elderly patients[J].J Clin Hepatol, 2012, 28 (10) :782-784. (in Chinese) 陈娟, 刘军, 邓登豪, 等.内镜下逆行胰胆管造影术治疗老年胆总管巨大结石40例[J].临床肝胆病杂志, 2012, 28 (10) :782-784. [7]KATSINELOS P, PAROUTOGLOU G, KOUNTOURAS J, et al.Efficicacy and safety of therapeutic ERCP in patient 90 years of age and older[J].Gastrointest Endosc, 2006, 63 (3) :417-423. [8]HAO JF, HU LH, LIAO Z, et al.Safety and efficacy of therapeutic ERCP for patients of over 90 years of age[J].Chin J Dig Endosc, 2012, 29 (10) :558-562. (in Chinese) 郝俊峰, 胡良皋, 廖专, 等.90岁及以上高龄患者行治疗性经内镜逆行胰胆管造影术的安全性与有效性评价[J].中华消化内镜杂志, 2012, 29 (10) :558-562.
本文二维码
计量
- 文章访问数: 2679
- HTML全文浏览量: 23
- PDF下载量: 557
- 被引次数: 0