Analysis Of The Effect And Safety Of Endoscopic EST+EPBD Treat Elderly Patients Complex Choledocholithiasis

Objective:To investigate the efficacy and safety of endoscopic sphincterotomy combined with endoscopic balloon dilatation(EST+EPBD)in the treatment of difficult bile duct stones in the elderly,and the influencing factors of postoperative complications in the elderly.Method:926 patients underwent ERCP examination in the Second Affiliated Hospital of Kunming Medical University from May 2016 to August 2018 were collected.246 patients with difficult bile duct stones and complete EST+EPBD treatment data were selected and their clinical data were analyzed retrospectively.According to the age group,aged?60 years old is the elderly group,and<60 years old is the non-elderly group.the clinical efficacy and complications of the two groups were analyzed,and the related factors of complications in the elderly group were analyzed by single and multiple factorsResult:246 cases were selected,140 males and 106 females,with an average age of(60.93±14.36)years.149 cases in the elderly group,with an average age of(71.57±7.82)years and 97 cases in the non-elderly group,with an average age of(46.28±9.35).The success rate of primary and secondary stone extraction and total stone extraction rate in the elderly group are 66.4%,88.6%and 96.0%respectively,and the operation time is 45.00(36.00?60.00)min.The success rate of primary and secondary stone removal and the total stone removal rate in the non-elderly group were 72.2%,91.7%and 96.9%respectively,and the operation time is also 45.00(36.00?60.00)min.There was no significant difference in the primary and secondary stone removal rates,total stone removal rate and operation time between the two groups(P>0.05).The incidence of complications in the elderly group was 43.6%,among which the incidence of hemorrhage,pancreatitis and hyperamylasemia,was 4.7%,6.7%and 32.2%,and 47.4%for non-elderly group,including 6.2%,8.2%and 33.0%for hemorrhage,pancreatitis and hyperamylasemia respectively.There was no perforation and cholangitis in the two groups.there was no significant difference in the incidence of complications of hemorrhage,perforation,pancreatitis,cholangitis and hyperamylasemia between the two groups(P>0.05).There were 2 postoperative deaths(1.34%)in the elderly group and 1 severe pancreatitis death(1.03%)in the non-elderly group.Although the mortality rate in the elderly group was slightly higher than that in the non-elderly group,the difference was not statistically significant(P>0.05).Logistic regression analysis showed that complicated with papillary diverticula,stricture of lower bile duct,balloon diameter,operation time,mechanical lithotripsy,stone diameter and bile duct diameter were the influencing factors of postoperative pancreatitis(P<0.05).Larger stone diameter,mechanical lithotripsy and bile duct diameter were the independent risk factors of postoperative pancreatitis However,complications such as papillary diverticula,bile duct stenosis,stone size and operation time are the influencing factors of postoperative hemorrhage(P<0.05),among which the lower bile duct stenosis and the larger stone diameter are the independent risk factors of postoperative hemorrhage.Conclusion:1.EST+EPBD is safe and effective in the treatment of difficult bile duct stones in the elderly.2.Lower bile duct stenosis and stone diameter are independent risk factors for hemorrhage after EST+EPBD.Stone diameter,bile duct diameter and mechanical lithotripsy are independent risk factors for pancreatitis after EST+EPBD.