内镜下逆行胰胆管造影治疗老龄胆总管结石疗效分析

发布时间：2018-04-29 07:52

本文选题：逆行胰胆管造影术 + 胆总管结石　；参考：《石河子大学》2015年硕士论文

【摘要】：目的:通过比较60岁以上老龄患者内镜下逆行胰胆管造影(endscopic retrograde cholangiopancrentography,ERCP)的应用情况,探讨ERCP治疗老龄胆总管结石临床疗效,分析和研究ERCP治疗老龄胆总管结石的安全性及有效性。方法:对我院2009年1月-2013年1月明确诊断为胆总管结石的60岁以上老龄患者967例临床资料回顾性分析,年龄60-95岁,平均年龄74.8岁,其中男性526例、女性441例。记录所有60岁以上老龄胆总管结石患者术前、术后血常规、血尿淀粉酶、肝功能;既往病史、既往手术史、临床症状;ERCP手术治疗方式、十二指肠憩室、结石数量、大小及性状;手术操作成功率、取石次数、结石取净率、并发症。对以上结果行统计学分析。结果:967例老龄胆总管结石患者中7例因心肺功能差经积极内科治疗后未达到手术要求或耐受性差、胃肠蠕动过快无法配合未实施ERCP治疗,3例因术中穿孔转外科治疗,ERCP成功治疗957例,ERCP操作成功率为99.3%,首次插管成功率为96.5%,手术成功率98.9%;结石一次取净864例,2次ERCP取净结石48例,累积两次结石取净率96%。放置胆道支架置入术22例,ERCP后总胆红素:64.5±105.9umol/l;术后直接胆红素:36.7±59.8umol/l;术后谷丙转氨酶:61.8±71.2u/l;术后谷草转氨酶:50.3±61u/l。术后肝功明显好转(P0.05)。术后2h血淀粉酶113±161u/l,无统计学差异(P0.05),24h血淀粉酶126.9±219.9u/l,与术前相比有统计学差异(P0.05)。术后腹痛、寒战、发热、黄疸均有不同程度的减轻或消失术后并发症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,无一例死亡。结论:1.老龄患者身体基础条件差并患有其他疾病,治疗性ERCP克服了老龄胆总管结石治疗中的影响因素,使年龄、既往史不再是手术禁忌症。2.ERCP治疗老龄胆总管结石疗效显著,由于老龄患者常合并其他疾病,治疗难度大、手术风险性高及并发症多,ERCP以独特优势避免老龄胆总管结石治疗中出现的问题。3.治疗性ERCP安全、有效,是老龄胆总管结石的首选治疗方法。
[Abstract]:Objective: to compare the application of endoscopic retrograde cholangiopancreatography (retrograde) and cholangiopancreatography (ERCP) in elderly patients over 60 years of age, to explore the clinical efficacy of ERCP in the treatment of senile choledocholithiasis, and to analyze and study the safety and efficacy of ERCP in the treatment of senile choledocholithiasis. Methods: the clinical data of 967 patients over 60 years old diagnosed as choledocholithiasis in our hospital from January 2009 to January 2013 were retrospectively analyzed. The age was 60-95 years old with an average age of 74.8 years, including 526 males and 441 females. All patients over 60 years old with choledocholithiasis were recorded before and after operation, blood routine examination, hematuria amylase, liver function, previous history of disease, history of operation, clinical symptoms of ERCP, duodenal diverticulum, number, size and character of stones. The successful rate of operation, the times of stone removal, the rate of stone removal and complications. The above results were analyzed statistically. Results among 967 aged patients with choledocholithiasis, 7 patients with choledocholithiasis failed to meet the surgical requirements or had poor tolerance due to poor cardiopulmonary function after active medical treatment. Gastrointestinal peristalsis could not be combined with ERCP in 3 cases. The successful rate of operation was 99.3, the success rate of first intubation was 96.5, and the success rate of operation was 98.90.The lithotripsy was removed in 864 cases with ERCP for 2 times in one time, and 48 cases were removed by ERCP at one time, the success rate of first intubation was 96.5a, and the success rate of operation was 98.90.The operative success rate was 98.9%. The cumulative twice stone removal rate was 96%. After ERCP, total bilirubin: 64.5 卤105.9 umoll / L; direct bilirubin: 36.7 卤59.8 umolr / L; postoperative glutamate-pyruvic transaminase: 61.8 卤71.2 u / L; postoperative aspartate aminotransferase: 50.3 卤61uP / l; postoperative total bilirubin: 64.5 卤105.9 umol / L; postoperative direct bilirubin: 36.7 卤59.8 umolr / l; The liver function was obviously improved after operation (P 0.05). 2 hours after operation, there was no significant difference in serum amylase (113 卤161u / l). There was no significant difference in serum amylase (126.9 卤219.9u / l) between two hours after operation, and there was a significant difference between the two groups before and after operation (P 0.05). Postoperative abdominal pain, shivering, fever and jaundice were alleviated or disappeared in 36 cases. The incidence of complications was 3.7, including 11 cases of acute pancreatitis, 12 cases of acute cholangitis, 10 cases of hemorrhage and 3 cases of perforation. All patients were cured and discharged after symptomatic treatment, and no one died. Conclusion 1. The aged patients had poor physical condition and other diseases. The therapeutic ERCP overcame the influencing factors in the treatment of choledocholithiasis, so that age and past history were no longer the contraindication of surgery. 2. ERCP was effective in the treatment of senile choledocholithiasis. Because the elderly patients often complicated with other diseases, the treatment is difficult, the operation risk is high and the complications are many. ERCP has a unique advantage to avoid the problem of common bile duct stone treatment. 3. Therapeutic ERCP is safe and effective. It is the first choice of treatment for choledocholithiasis in elderly patients.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.4

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