老年患者治疗性内镜逆行胰胆管造影的临床分析  

Clinical analysis of therapeutic endoscopic retrograde cholangiopancreatography in elderly patients

作　　者：韩宏锋[1] 陈虹[1] 薛伟红[1] 

机构地区：[1]洛阳市中心医院消化内科,河南洛阳471009

出　　处：《临床荟萃》2012年第7期559-561,共3页Clinical Focus

摘　　要：目的研究治疗性内镜逆行胰胆管造影(ERCP)对老年患者的临床治疗有效性和安全性。方法回顾性分析2009年4月至2011年12月我科123例行ERCP治疗的老年胆胰疾病患者,观察ERCP治疗成功率及并发症发生情况。结果 123例患者,年龄为75～91岁,胆总管结石91例(74.0%),胆管良性狭窄3例(2.4%),胆管恶性狭窄29例(23.6%),伴有合并症83例(67.5%)。ERCP治疗成功119例(96.7%)。术后发生并发症9例(7.3%),胰腺炎6例,胆管感染2例,其中急性胰腺炎合并胆管感染1例,十二指肠乳头括约肌切开(EST)后迟发出血1例。除急性重症胰腺炎合并胆管感染1例死亡外,余均经治疗后痊愈出院。结论老年患者不应该作为治疗性ERCP的禁忌证,即使合并有心肺系统疾病,经过充分的术前准备,采用简洁有效的手术方式,减少操作时间,并没有增加严重并发症的发生。老年患者ERCP的并发症发生率较高可能与恶性肿瘤所占比例高有关,与合并其他系统疾病未必有关联。Objective To study the clinical efficacy and safety of therapeutic endoscopic retrograde cholangiopancreatography（ERCP） for elderly patients. Methods Retrospective analysis was made on 123 elderly patients with bile duct and pancreatic diseases who got treatment with ERCP in the department from April 2009 to December 2011. The success rate and complications were observed and statistically analyzed. Results 123 patients aged 75 to 91 years old were treated with ERCP,including 91 cases（74.0%） with bile duct stones,3 cases（2.4%） with bile duct benign stricture and 29 cases（23.6 ） bile duct malignant narrow, 83 cases （67.5% ） with complications. 119 cases（96.7% ） were successfully treated with ERCP. Postoperative complications occurred in 9 cases（7.3 % ）, pancreatitis 6 cases,bile duct infection 2 cases including acute pancreatitis with bile duct infection in 1 case, late bleeding after duodenal nipple sphincter（EST） cut in 1 case. Except 1 case with severe acute pancreatitis and bile duct infection died, all patients were discharged after treatment. Conclusion Elderly patients should not be included as therapeutic ERCP contraindication. By effective procedure, less operating time, serious complications of elderly patients with cardiopulmonary system disease did not increase. Elderly patients in ERCP have high incidence of complications, the reasons of which were possibly related to the high rate of malignant tumor hut were not necessarily associated with other system diseases.

关 键 词：胆道疾病 胰腺疾病 胰胆管造影术 内窥镜逆行 治疗 老年人 

分 类 号：R575[医药卫生—消化系统] R576[医药卫生—内科学]