高龄老人内镜逆行胰胆管造影诊疗安全性评价

发布时间：2018-06-20 13:46

本文选题：老年人 + 经内镜逆行胰胆管造影　；参考：《中国内镜杂志》2017年10期

【摘要】：目的探讨高龄老人(80岁)经内镜逆行胰胆管造影(ERCP)诊疗的安全性。方法回顾性分析80例实施ERCP诊治的80岁以上老年患者,评估既往疾病谱对ERCP操作的影响并进行相应干预,在尽可能短的时间内完成ERCP操作,术后围手术期严格管理,检测血常规、血尿淀粉酶及必要生化指标,1周内检测有无继发或加重其他脏器损伤。结果 80例80岁以上患者中11例(13.75%)合并重要脏器疾病,2种以上疾病者占51.25%(41/80)。77例(96.25%)顺利完成内镜下治疗,一次取石成功率为74.55%(41/55),3例无法行二次取石患者内镜下将鼻胆引流管剪断改为内引流;1例胰腺癌并十二指肠狭窄患者先行狭窄肠腔扩张后ERCP置入胆道金属支架,后行十二指肠支架置入。80例患者中1例胰腺癌并胆总管结石患者ERCP行胆道金属支架置入后1周继发肾衰,死于心衰、呼吸衰竭;无其他严重并发症发生,总的并发症发生率为7.50%,ERCP平均操作时间为(26.64±8.31)min。结论高龄老人(80岁)行ERCP操作相对比较安全,术后效果明显,围手术期全程进行管理,可降低并发症发生。
[Abstract]:Objective to evaluate the safety of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of the elderly aged 80 years. Methods 80 patients over 80 years old who were diagnosed and treated with ERCP were analyzed retrospectively. The influence of previous disease spectrum on ERCP operation was evaluated and the corresponding intervention was carried out. The ERCP operation was completed in the shortest possible time, and the perioperative period was strictly managed. Blood routine, urine amylase and necessary biochemical indexes were detected in 1 week. Results among 80 patients over 80 years of age, 11 cases (13.75%) were complicated with two or more important organ diseases, accounting for 51.25% of 41 / 80% (77 cases) successfully completed endoscopic treatment. The success rate of one lithotomy was 74.55% 41 / 55% 3 cases could not be treated with secondary lithotomy. Endoscopic transection of nasobiliary drainage tube was replaced by internal drainage. One patient with pancreatic carcinoma and duodenal stricture was treated with ERCP after dilation of the stricture of intestinal cavity and placement of biliary metal stent. One of 80 patients with pancreatic cancer and choledocholithiasis was treated with ERCP. The secondary renal failure occurred 1 week after the stent implantation, and died of heart failure and respiratory failure. No other serious complications occurred. The average operating time of ERCP was 26.64 卤8.31 min. Conclusion ERCP is a relatively safe and effective procedure for the elderly aged 80 years. Management during the whole perioperative period can reduce the incidence of complications.
【作者单位】：河北省人民医院消化一科;
【分类号】：R57

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