本文選題：逆行胰膽管造影術(shù) + 膽總管結(jié)石�。� 參考：《石河子大學(xué)》2015年碩士論文

【摘要】：目的:通過比較60歲以上老齡患者內(nèi)鏡下逆行胰膽管造影(endscopic retrograde cholangiopancrentography,ERCP)的應(yīng)用情況,探討ERCP治療老齡膽總管結(jié)石臨床療效,分析和研究ERCP治療老齡膽總管結(jié)石的安全性及有效性。方法:對我院2009年1月-2013年1月明確診斷為膽總管結(jié)石的60歲以上老齡患者967例臨床資料回顧性分析,年齡60-95歲,平均年齡74.8歲,其中男性526例、女性441例。記錄所有60歲以上老齡膽總管結(jié)石患者術(shù)前、術(shù)后血常規(guī)、血尿淀粉酶、肝功能;既往病史、既往手術(shù)史、臨床癥狀;ERCP手術(shù)治療方式、十二指腸憩室、結(jié)石數(shù)量、大小及性狀;手術(shù)操作成功率、取石次數(shù)、結(jié)石取凈率、并發(fā)癥。對以上結(jié)果行統(tǒng)計學(xué)分析。結(jié)果:967例老齡膽總管結(jié)石患者中7例因心肺功能差經(jīng)積極內(nèi)科治療后未達(dá)到手術(shù)要求或耐受性差、胃腸蠕動過快無法配合未實(shí)施ERCP治療,3例因術(shù)中穿孔轉(zhuǎn)外科治療,ERCP成功治療957例,ERCP操作成功率為99.3%,首次插管成功率為96.5%,手術(shù)成功率98.9%;結(jié)石一次取凈864例,2次ERCP取凈結(jié)石48例,累積兩次結(jié)石取凈率96%。放置膽道支架置入術(shù)22例,ERCP后總膽紅素:64.5±105.9umol/l;術(shù)后直接膽紅素:36.7±59.8umol/l;術(shù)后谷丙轉(zhuǎn)氨酶:61.8±71.2u/l;術(shù)后谷草轉(zhuǎn)氨酶:50.3±61u/l。術(shù)后肝功明顯好轉(zhuǎn)(P0.05)。術(shù)后2h血淀粉酶113±161u/l,無統(tǒng)計學(xué)差異(P0.05),24h血淀粉酶126.9±219.9u/l,與術(shù)前相比有統(tǒng)計學(xué)差異(P0.05)。術(shù)后腹痛、寒戰(zhàn)、發(fā)熱、黃疸均有不同程度的減輕或消失術(shù)后并發(fā)癥36例,并發(fā)癥發(fā)生率3.7%,其中急性胰腺炎11例,急性膽管炎12例,出血10例,穿孔3例,經(jīng)對癥治療后均治愈出院,無一例死亡。結(jié)論:1.老齡患者身體基礎(chǔ)條件差并患有其他疾病,治療性ERCP克服了老齡膽總管結(jié)石治療中的影響因素,使年齡、既往史不再是手術(shù)禁忌癥。2.ERCP治療老齡膽總管結(jié)石療效顯著,由于老齡患者常合并其他疾病,治療難度大、手術(shù)風(fēng)險性高及并發(fā)癥多,ERCP以獨(dú)特優(yōu)勢避免老齡膽總管結(jié)石治療中出現(xiàn)的問題。3.治療性ERCP安全、有效,是老齡膽總管結(jié)石的首選治療方法。
[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 鹵105.9 umoll / L; direct bilirubin: 36.7 鹵59.8 umolr / L; postoperative glutamate-pyruvic transaminase: 61.8 鹵71.2 u / L; postoperative aspartate aminotransferase: 50.3 鹵61uP / l; postoperative total bilirubin: 64.5 鹵105.9 umol / L; postoperative direct bilirubin: 36.7 鹵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 鹵161u / l). There was no significant difference in serum amylase (126.9 鹵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.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R657.4

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本文編號：1819064