Clinical Study Of Endoscopic Treatment To Elderly Patients With CBD Stones

Objective:Choledocholith, as a common disease in china, is not only a main risk factor of acute suppurative cholangitis or acute biliary pancreatitis, but also an important cause of obstructive jaundice; on the other hand, the risk of mortality increases in severe cases while within which the senile patients account for the majority. Furthermore,those aged patients are always more inclined to suffer some other severe complications, which may exactly be the contraindications for the surgical procedures in most cases.Thus, an ERCP management for the removal of biliary tract calculus under these circumstances might be the most feasible choice. This study is focused on the effectiveness of the ERCP treatment for choledocholith, in which all the applicants who have been previously diagnosed as choledocholith or huge calculus complicated with acute biliary pancreatites or acute suppurative cholangites are above 60 years old. It is through the investigation on the influences by factors such as calculus causes, risk factors, treated times, procedure options, EST,EPBD,ERBD,ENBD and ERPB to the curative effects that do we try to seek a more effective treated approach to the choledocholith.Methods:Analysis the effect of the endoscopy therapy to the cases from 2009.1 to 2010.12,age>60 years old.Treat the patients timely by ERCP, with EST,EPBD, stone-free treatment, ERBD and ERPD.The patients whose stones couldnot be moved for one time because of all-cause were treated with ENBD or ERBD,and then for the second stone-free; Patients with biliary pancreatitis were treated with double-EST,some patients with ERPD. We can evaluate the effect of treatment by the level of the calculus removing,the remission of symptom after treatment,the incidence of ERCP complication and so on.Results:Cases for 132 cases, including male 71cases, female 61 cases.60-69 years old 48 cases,70-79 years old 54 cases,80-89 years old 29 cases, over 90s 1 case, with an average age of 71.73 years old; patients with only one stone 43 cases multiple stones 89 cases, huge stone (> 1.0cm) 76 cases, cases with acute biliary pancreatitis 4 cases.(1) Stone-free success in 130 cases,98.48%,2 cases because of papillomas in diverticulas without success; Cases whose stones were removed for one time in 116 cases (89.23%), the others whose stones not completely removed were retreated with ENBD or ERBD, and then for the secondary treatment, completely stone-free rate was 100%.(2) Complications of ERCP:post-ERCP pancreatitis 5cases (3.79%), biliary infection (including cholangitis, cholecystitis) 3cases (2.27%), recent hemorrhage 18 cases (13.64%), delayed hemorrhages in 0 case, gastrointestinal perforation in 0 case, biliary stents shift the 3 cases (2.27%), biliary stents jam the 2 cases (1.52%).(3) There are 31 cases with acute biliary pancreatitis, and the stone-free rate was 100%, postoperative within 24 hours of abdominal pain obviously alleviate in 25cases (80.65%), alleviate after 24 hours in 6 cases (19.35%), no pancreatitis aggravating.(4) There are 4 cases combined with acute obstructive suppurative cholangitis successful rate was 100%.(5) there are 33cases of diverticulum papilla and successful in 31 cases.(6) with a serious complications:7cases, safety stone-free rate 100%.(7)with pancreatic duct stone:2 cases,pancreatic stone-free rate 100%.Conclusion:the results of the study indicated that:As a kind of endoscopic intervention minimally invasive treatment in older patients with CBD stones, ERCP is a safe and effective treatment. Even if the stones cannot be removed or cannot be completely removed due to various causes, endoscopic retrograde biliary drainage with plastic bile ducts also can obtain the very good curative effect; For patients with acute biliary pancreatitis, especially recurrent biliary pancreatitis, ERCP and EST can not only solve the incidence of sickness, Shorter hospital stay, reduce complications, but also can prevent the recurrence. ERCP has overcome many difficulties that surgical cannot overcome, and has advantages those surgery cannot replace, and ERCP has the trend to replace surgery. But we should also pay many attentions to the choice of methods during ERCP intraoperatie,such as the choice of specific EPBD or EST, etc.