ERCP治疗老年胆总管结石合并心脑血管疾病病人的疗效分析
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摘要
目的评价行内镜逆行胰胆管造影术(ERCP)治疗合并心脑血管疾病的老年胆总管结石病人的有效性和安全性。方法回顾性分析在我院行ERCP治疗的175例70岁以上胆总管结石病人的临床资料,对临床特征、内镜诊治情况、并发症等进行分析。结果 175例老年病人中伴有高血压35例,冠心病13例,糖尿病25例,脑血管疾病18例,慢性阻塞性肺疾病(COPD)6例,存在十二指肠憩室77例, ERCP治疗成功174例,取石成功171例,术后发生胰腺炎7例,术中出血11例,穿孔1例。结论老年病人基础疾病多,常合并高血压、冠心病、糖尿病,在严格掌握适应证的条件下,老年胆总管结石病人行ERCP治疗是安全有效的。
引文
[1] PONCHON T,PILLEUL F.Diagnostic ERCP[J].Endoscopy,2002,34(1):29-42.
[2] BOVE A,DIRENZO R M,PALONE G,et al.Which differences do elderly patients present in single-stage treatment for cholecysto-choledocholithiasis?[J].Int J Surg,2014,12(2):S160-S163.
[3] ADLER D G,BARON T H,DAVILA R E,et al.ASGE guideline:the role of ERCP in diseases of biliarytract and the pancreas[J].Gastrointest Endosc,2005,62(1):18.
[4] GARCIA C J,LOPEZ O A,ISLAM S,et al.Endoscopic retrograde cholangiopancreatography in the elderly[J].Am J Med Sci,2016,351(1):84-90.
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[7] 陈海昕,袁楚明,林贵海,等.急诊ERCP治疗老年人急性化脓性胆管炎的疗效观察[J].中国实用医药,2016,11(27):142-143.
[8] KIM K H,KIM T N.Endoscopic papillary large balloon dilation in patients with periampullary diverticula[J].World J Gastroenterol,2013,19(41):7168-7176.
[9] OZOGUL B,OZTURK G,KISAOGLU A,et al.The clinical importance of different localizations of the papilla associated with juxtapapillary duodenal diverticula[J].Can J Surh,2014,57(5):337-341.
[10] PARLAK E,K?KSAL A S,DI?IBEYAZ S,et al.Additional biliary cannulation methods in patients with juxtapapillary duodenal diverticula[J].Dig Dis Sci,2017,57(11):2982-2987.
[11] 文明,王建明,贺奇斌,等.十二指肠憩室对胆管插管时间及术后并发症的影响研究[J].中华消化内镜杂志,2016,33(8):543-546.
[12] GURUNG R B,PURBEY B,KOJU R,et al.Endoscopic retrograde cholangiopancreatography at Dhulikhel Hospital:outcome analysis[J].Kathmandu Univ Med J(KUMJ),2014,12(45):55-59.
[13] BAI Y,GAO F,GAO J,et al.Prophylactic antibiotic cannot prevent endoscopic retrograde cholangiopancreatography-induced cholangitis:a meta-analysis[J].Pancreas,2009,38(2):126-130.
[14] 黄艳玲,李俊玲,高瑞,等.十二指肠镜的重复消毒对经内镜逆行胰胆管造影术后胆管炎发病率的影响[J].中华全科医学,2017,15(3):515-517.
[15] KATSINELOS P,KOUNTOURAS J,CHATZIMAVROUDIS G,et al.Outpatient therapeutic endoscopic retrograde cholangiopancreatography is safe in patients aged 80 years and older[J].Endoscopy,2011,43(2):128-133.
[16] ANDRIULLI A,LOPERFIDO S,NAPOLITANO G,et al.Incidence rates of post-ERCP complications:a systematic survey of prospective studies[J].Am J Gastroenterol,2007,102(8):1781-1788.
[17] KOCHAR B,AKSHINTALA V S,AFGHANI E,et al.Incidence,severity,and mortality of post-ERCP pancreatitis:a systematic review by using randomized,controlled trials[J].Gastrointest Endosc,2015,81:143-149.
[18] 中华医学会消化内镜学分会,中国医师协会胰腺病专业委员会.内镜下逆行胰胆管造影术后胰腺炎药物预防专家共识意见(2015年,上海)[J].中华消化内镜杂志,2015,32(12):794-799.
[19] KANAMORI A,KIRIYAMA S,TANIKAWA M,et al.Long-and short-term outcomes of ERCP for bile duct stones in patients over 80 years old compared to younger patients:a propensity score analysis[J].Endosc Int Open,2016,4(1):E83-E90.
[2] BOVE A,DIRENZO R M,PALONE G,et al.Which differences do elderly patients present in single-stage treatment for cholecysto-choledocholithiasis?[J].Int J Surg,2014,12(2):S160-S163.
[3] ADLER D G,BARON T H,DAVILA R E,et al.ASGE guideline:the role of ERCP in diseases of biliarytract and the pancreas[J].Gastrointest Endosc,2005,62(1):18.
[4] GARCIA C J,LOPEZ O A,ISLAM S,et al.Endoscopic retrograde cholangiopancreatography in the elderly[J].Am J Med Sci,2016,351(1):84-90.
[5] 庄心良,曾因明,陈伯銮.现代麻醉学[M].北京:人民卫生出版社,2003:525.
[6] 周宁新,万涛.肝胆管结石的基础与临床——肝胆管结石病的外科治疗决策[J].中国实用外科杂志,2004,24(2):67.
[7] 陈海昕,袁楚明,林贵海,等.急诊ERCP治疗老年人急性化脓性胆管炎的疗效观察[J].中国实用医药,2016,11(27):142-143.
[8] KIM K H,KIM T N.Endoscopic papillary large balloon dilation in patients with periampullary diverticula[J].World J Gastroenterol,2013,19(41):7168-7176.
[9] OZOGUL B,OZTURK G,KISAOGLU A,et al.The clinical importance of different localizations of the papilla associated with juxtapapillary duodenal diverticula[J].Can J Surh,2014,57(5):337-341.
[10] PARLAK E,K?KSAL A S,DI?IBEYAZ S,et al.Additional biliary cannulation methods in patients with juxtapapillary duodenal diverticula[J].Dig Dis Sci,2017,57(11):2982-2987.
[11] 文明,王建明,贺奇斌,等.十二指肠憩室对胆管插管时间及术后并发症的影响研究[J].中华消化内镜杂志,2016,33(8):543-546.
[12] GURUNG R B,PURBEY B,KOJU R,et al.Endoscopic retrograde cholangiopancreatography at Dhulikhel Hospital:outcome analysis[J].Kathmandu Univ Med J(KUMJ),2014,12(45):55-59.
[13] BAI Y,GAO F,GAO J,et al.Prophylactic antibiotic cannot prevent endoscopic retrograde cholangiopancreatography-induced cholangitis:a meta-analysis[J].Pancreas,2009,38(2):126-130.
[14] 黄艳玲,李俊玲,高瑞,等.十二指肠镜的重复消毒对经内镜逆行胰胆管造影术后胆管炎发病率的影响[J].中华全科医学,2017,15(3):515-517.
[15] KATSINELOS P,KOUNTOURAS J,CHATZIMAVROUDIS G,et al.Outpatient therapeutic endoscopic retrograde cholangiopancreatography is safe in patients aged 80 years and older[J].Endoscopy,2011,43(2):128-133.
[16] ANDRIULLI A,LOPERFIDO S,NAPOLITANO G,et al.Incidence rates of post-ERCP complications:a systematic survey of prospective studies[J].Am J Gastroenterol,2007,102(8):1781-1788.
[17] KOCHAR B,AKSHINTALA V S,AFGHANI E,et al.Incidence,severity,and mortality of post-ERCP pancreatitis:a systematic review by using randomized,controlled trials[J].Gastrointest Endosc,2015,81:143-149.
[18] 中华医学会消化内镜学分会,中国医师协会胰腺病专业委员会.内镜下逆行胰胆管造影术后胰腺炎药物预防专家共识意见(2015年,上海)[J].中华消化内镜杂志,2015,32(12):794-799.
[19] KANAMORI A,KIRIYAMA S,TANIKAWA M,et al.Long-and short-term outcomes of ERCP for bile duct stones in patients over 80 years old compared to younger patients:a propensity score analysis[J].Endosc Int Open,2016,4(1):E83-E90.