内镜逆行胰胆管造影术应用于高龄胆管结石合并十二指肠憩室患者的安全性及临床疗效观察

Safety and clinical observation of endoscopic retrograde cholangiopancreatography (ERCP) treatment for elderly patients with choledocholithiasis and periampullary diverticula

摘要:

目的 探讨内镜逆行胰胆管造影术（ERCP）应用于高龄胆管结石合并十二指肠憩室患者的安全性及临床疗效。方法 收集2012年6月－2018年6月于苏北人民医院行ERCP检查的300例高龄胆管结石患者的临床资料，根据有无合并十二指肠憩室分为两组，A组为十二指肠憩室患者，B组为非十二指肠憩室患者，比较两组患者胆管结石的复发率、不同憩室类型的胆管结石复发的差异、ERCP应用于高龄胆管结石患者的安全性及术后并发症。结果 A组胆管结石复发率为32.08%，B组为18.58%，两组比较，差异有统计学意义（P < 0.05）。十二指肠憩室内乳头患者的胆管结石复发率高于憩室旁乳头及憩室间乳头患者，差异有统计学意义（P < 0.05）。300例患者的取石成功率为93.00%，其中一次性成功取石231例，48例行第2次ERCP术后完全取出，21例取石失败。ERCP术后并发症发生率4.33%，其中高淀粉酶血症8例，一过性胆管炎2例，轻型急性胰腺炎3例，均经内科保守治疗后好转。结论 应用ERCP治疗高龄胆管结石的安全性较好，十二指肠憩室可促进胆管结石形成，其中憩室内乳头对结石的复发有较大影响。

Abstract:

Objectives To investigate the safety and clinical observation of endoscopic retrograde cholangiopancreatography (ERCP) treatment for elderly patients with choledocholithiasis and periampullary diverticula.Methods Clinical data of 300 choledcholithiasis patients underwent ERCP, from June 2012 to June 2018 were collected and retrospectively analyzed. All the patients were 80 years of age or older. The patients were divided into two groups: group A comprising 187 patients with duodenal diverticula, and group B comprising 113 patients without diverticula. The recurrence rate of choledocholithiasis, the difference of the recurrence rate in different type of duodenal diverticula, and the safety and complication of ERCP were compared between the two groups.Results The recurrence rate of choledocholithiasis in group A is higher than that in group B (32.08% vs 18.58%, P < 0.05). The recurrence rate in patients with duodenal papilla situated inside a diverticulum is higher than patients with periampullary position of diverticula and located between the two diverticula (P < 0.05). The stones were successfully removed in 279 (93.00%) patients. Due to lager stones, 48 patients were failure to remove the stone in one time, and were successfully removed at second time. There were 13 (4.33%) complications (eight hyperamylasemia, two cholangitis, and three mild acute pancreatitis). All these patients were recovered by internal treatment.Conclusion ERCP is a safe and effective intervention in patients 80 years of age or older. Duodenal diverticula can be associated with choledocholithiasis, especially in patients with duodenal papilla situated inside a diverticulum.