目的:对于高危老年慢性病患者,大型胆总管结石的内镜取石术与不良事件和取石不完全的高风险相关.这项研究的目的是研究短期胆道塑料支架置入后选择性内镜取石的治疗策略是否比立即内镜取石更有效和更安全。
方法:回顾性分析2017-2022年262例经内镜逆行胰胆管造影术(ERCP)治疗胆总管大结石的高危老年患者的临床资料。将患者分为A组(即刻取石)和B组(支架引流术+择期取石)。2组基线资料按倾向评分匹配1:1进行匹配。结石清除率,ERCP手术时间,总住院时间,在匹配组之间比较与手术相关的不良事件.B组,支架置入前后结石大小,住院,比较了两种ERCPs的手术时间和不良事件.
结果:两组共57对患者成功配对。B组结石清除率高于A组(89.5%vs.75.3,P=0.049)。B组总住院时间长于A组(11.86±3.912dvs.19.14±3.176d,P<0.001)。A组的总不良事件发生率高于B组(29.8%vs.12.3%,P=0.005)。A组ERCP术后胆管炎/胆囊炎的发生率明显高于B组(7.0%vs.0.9%P=0.029)。ERCP术后胰腺炎的发生率无显著差异,出血,肺炎,两组之间的心脑血管事件。两组均无穿孔病例。B组塑料胆道支架置入术后,结石大小明显小于支架置入前(1.59±0.544cmvs.1.95±0.543cm,P<0.001),两种ERCP程序之间的总不良事件发生率没有显着差异(18.8%vs.10.9%,P=0.214)。
结论:对于患有大型CBD结石的高危老年患者,包括临时放置塑料支架和择期内镜取石的治疗策略比立即取石更安全有效.
OBJECTIVE: For high-risk elderly patients with chronic diseases, endoscopic stone removal for large common bile duct stones is associated with a high risk of adverse events and incomplete stone removal. The aim of this
study was to investigate whether the treatment strategy of short-term biliary plastic stent placement followed by elective endoscopic stone removal is more effective and safer than immediate endoscopic stone removal.
METHODS: The data of 262 high-risk elderly patients who received endoscopic retrograde
cholangiopancreatography (ERCP) for large common bile duct (CBD) stones from 2017 to 2022 were retrospectively analyzed. The patients were divided into group A (immediate stone removal) and group B (stent drainage + elective stone removal). The baseline data of the 2 groups were matched 1:1 by propensity score matching. The stone clearance rate, ERCP procedure time, total hospital stay, and procedure-related adverse events were compared between the matched groups. In group B, stone size before and after stent placement, hospital stay, procedure time and adverse events of two ERCPs were compared.
RESULTS: A total of 57 pairs of patients were successfully matched between the 2 groups. The stone clearance rate in group B was higher than that in group A (89.5% vs. 75.3, P = 0.049). The total hospital stay in group B was longer than that in group A (11.86 ± 3.912 d vs. 19.14 ± 3.176 d, P<0.001). The total adverse event rate in group A was higher than that in group B (29.8% vs. 12.3%, P = 0.005). The incidence of cholangitis/cholecystitis after ERCP was significantly higher in group A than in group B (7.0% vs. 0.9% P = 0.029). There was no significant difference in the incidence of post-ERCP pancreatitis, bleeding, pneumonia, and cardio-cerebrovascular events between the 2 groups. There were no perforation cases in either group. After plastic biliary stent placement in group B, the stone size was significantly smaller than before stent placement (1.59 ± 0.544 cm vs. 1.95 ± 0.543 cm, P < 0.001), and there was no significant difference in the total adverse event incidence between the two ERCP procedures (18.8% vs. 10.9%, P = 0.214).
CONCLUSIONS: For high-risk elderly patients with large CBD stones, the treatment strategy involving temporary placement of plastic stent and elective endoscopic stone removal is safer and more effective than immediate stone removal.