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目的探讨治疗性逆行胰胆管造影(ERCP)在老年胰胆疾病中的应用。方法回顾分析我院2009年1月~2014年12月82例≥75岁老年胆胰疾病患者治疗性ERCP的结果。结果82例患者插管成功78例,成功率为95.1%,其中胆总管结石59例(伴化脓性胆管炎11例,胆源性胰腺炎8例),胆总管良性狭窄3例,胆管癌5例(伴化脓性胆管炎2例),胰腺癌4例,壶腹部癌5例,胆总管结石合并肿瘤2例。胆总管结石行十二指肠乳头括约肌切开56例(其中预切开4例),十二指肠乳头括约肌扩张3例。一次完成取石45例,二次完成取石7例,放置塑料支架引流1例,伴化脓性胆管炎或胆源性胰腺炎先放置鼻胆管引流择期再取石6例;胆管梗阻患者放置塑料支架19例。术后发生并发症6例(7.7%),其中胰腺炎3例,消化道出血2例,胆管感染1例。取石成功后因肝肾功能衰竭死亡1例。结论老年胆胰疾病患者采用治疗性ERCP,术前充分的病情评估和准备,术中选择恰当的手术方式,缩短操作时间,是一种安全、有效、微创的治疗方法。
Objective To investigate the application of therapeutic reverse cholangiopancreatography (ERCP) in senile pancreaticobiliary disease. Methods A retrospective analysis of our hospital from January 2009 to December 2014 82 cases of ≥ 75 years old patients with biliary and pancreatic disease treatment ERCP results. Results 82 cases of successful intubation in 78 cases, the success rate was 95.1%, of which 59 cases of common bile duct stones (with suppurative cholangitis in 11 cases, biliary pancreatitis in 8 cases), bile duct stricture in 3 cases, cholangiocarcinoma 5 Cases (with suppurative cholangitis in 2 cases), pancreatic cancer in 4 cases, ampullary carcinoma in 5 cases, common bile duct stones in 2 cases. 56 cases of choledocholithotomy underwent duodenal papilla sphincter dissection (including 4 cases of pre-incision), and 3 cases of duodenal sphincter dilatation. 45 cases of stone were completed at one time, 7 cases were completed twice by stone scaffold, 1 case of plastic stent was placed and 6 cases were treated by choledochocholedochitis with drainage of suppurative cholangitis or gallstone pancreatitis. 19 cases of biliary obstruction were placed with plastic stent . Postoperative complications occurred in 6 cases (7.7%), of which 3 cases of pancreatitis, gastrointestinal bleeding in 2 cases, 1 case of bile duct infection. One case died of liver and kidney failure after successful stone removal. Conclusion The treatment of elderly patients with biliary and pancreatic diseases using ERCP, adequate preoperative condition assessment and preparation, intraoperative selection of the appropriate surgical approach to shorten the operation time is a safe, effective and minimally invasive treatment.