Clinical Efficacy Of Therapeutic ERCP In Patients ASC Caused By Choledocholithiasis In Elderly Patients

Objective:Acute suppurative cholangitis(ASCC)is an acute suppurative inflammation caused by increased pressure and bacterial infection after acute obstruction of bile duct.Choledocholithiasis occupies the first place in the etiology,followed by malignant tumor.Endoscopic retrograde cholangiopancreatography(ERCP),as a common therapeutic method of cholangiopancreatopancreatic diseases,can not only relieve the pressure of bile duct,but also relieve the symptoms of biliary obstruction.Compared with the traditional surgery,it has the following advantages: fast,soft and minimally invasive,more options,less complications,and so on.As a way of biliary drainage,nasobiliary duct can directly observe the bile drainage and indirectly judge the bile duct.It is widely used in clinical work and has a high practical value.This article is a retrospective review of the curative effect of treating choledocholithiasis caused by choledocholithiasis caused by choledocholithiasis by EST and ENBD under ERCP in our hospital for 6 years.To explore the clinical effect of EST lithotomy and ENBD under ERCP in the treatment of suppurative cholangitis caused by choledocholithiasis in elderly patients.The results showed that the advantage of EST+ ENBD extraction under therapeutic ERCP was obtained in elderly patients with suppurative cholangitis caused by choledocholithiasis.Method:During the period of September 2010 through August-2016,age ≥60 and in the first hospital of Shanxi Medical University for treatment of ERCP in this group and in accordance with the inclusion criteria of common bile duct stones with suppurative cholangitis in patients hospitalized in 432 cases,388 Cases of successful lithotomy,including emergency stone and drainage group(A group)209 cases(male: 101,female 108);the first stone group and elective drainage(B group)179 cases(male: 86,female 93).Detailed records of the two groups of patients before surgery,1: basic situation(gender,age,single or multiple stones,whether associated with biliary pancreatitis,severe acute cholangitis etc.);2,the success rate of stone(a stone,first lien ENBD,transferred to other departments with,etc.);3 within three days after surgery,liver function,abdominal pain,complications,and average hospitalization days.Result:1.the total number of cases in 432 cases,including 196 cases of male,female 236 cases;248 cases of 60 to 69 years of age,70 to 79 years in 154 cases,80-89 years old in 19 cases,90 cases of L years old;143 cases with solitary stones,multiple calculi in 289 cases,276 cases of calculi with diameter of >lcm;35 patients with biliary pancreatitis;43 cases with severe acute obstructive suppurative cholangitis,emergency stone in 40 cases,the success rate of 93.02%;in 24 cases with papillary diverticulum,20 cases of successful83.33%),around 67 cases of papillary diverticulum,61 cases were successful,the success rate of 91.04%.2.388 Cases were successful in stone extraction,and the success rate was 89.81%.In group A,209 cases(53.87%)were taken out of stone at one time.179 patients(46.13%)in group B were given ENBD drainage first and two times complete stone extraction.The total success rate was 100%.The rest of the 44 patients failed to take stones due to huge stones or anatomic abnormalities and then transferred to general surgery or other hospitals.3.The treatment of ERCP complications,3 days after operation,liver function,abdominal pain,3388 cases of liver function: 3 days after ERCP treatment: group A: ALT 122.76 +84.78 u 127.72 + 41.42 u,Delta AST,Delta TB 46.7 + 60.38;B group: ALT 135.61 + 48.8u,AST 147.72 TB + 81.20 u,61.23 + 51.84;347 patients(89.43%)abdominal pain remission;treatment of ERCP postoperative complications: 17 cases of pancreatitis(4.38%),biliary infection(including cholangitis and cholecystitis)in 3 cases(0.77%),56 cases of intraoperative bleeding blood(14.43%),2 cases of delayed bleeding(0.52%),5 cases of gastrointestinal perforation(1.29%),2 cases of nasal duct prolapse(0.52%).Specific to the two group,the abdominal pain: group A 188 cases(89.95%),B group(88.83%);159 cases of pancreatitis and 9 cases in A group(4.3%),B group(4.5%);8 cases of biliary infection:2 cases in A group(0.48%),B group of 1 cases(0.56%);a small amount of operation the bleeding,37 cases in A group(17.70%),B group(10.61%),19 cases of delayed hemorrhage: 2 cases in A group(0.96%),B group(0%);0 cases of nasal duct prolapse: A group of 2 cases(0.96%),0 cases in B group(0%).Postoperative naso biliary drainage and the average length of stay: 386 patients were treated with ERCP after operation,and 2cases were discharged.First days,second days and third days after operation,the drainage volume was 72.77 + 27.26 ml,129.36 + 24.52 ml,236.15 + 39.26 ml respectively.The average day of hospitalization was about 8.17 + 3.8 days in group A and 10.92 + 6.7 days in group B.Conclusion:As a means of interventional endoscopic therapy,ERCP therapy is safe and effective for elderly patients with distal common bile duct stones,even because of excessive or other physiological and pathological factors leading to a stone stone cannot be removed or cannot be completely removed,the first ENBD drainage,then ERCP+EST stone can also be obtained the satisfactory curative effect;emergency lithotomy and drainage group and drainage group stone again elective especially for severe acute obstructive suppurative cholangitis,emergency rescue stone with high success rate and low complication rate.If you do not take into account the size of the stones,single or multiple factors such as emergency stone and drainage of shorter hospital;in general,stone and emergency drainage and drainage after the first ENBD,ERCP+EST no difference stone two ways in restoring liver function,abdominal pain and complications.With the development of ERCP and other related new materials,therapeutic ERCP has a tendency to replace surgery in the middle and lower choledocholithiasis of the elderly.