Okuda Naoko, Sugimoto Shinya, Nakamura Haruka, Hisada Hirohisa, Temma Taishi, Hashimoto Yuki, Hayashi Satoshi, Ito Tatsuya, Takami Mayuko, Oyamada Jun, Kamei Akira
Divisions of Gastroenterology Ise Red Cross Hospital Mie Japan.
JGH Open. 2019 May 30;4(1):16-21. doi: 10.1002/jgh3.12198. eCollection 2020 Feb.
Endoscopic stone removal has some complications. Although the life expectancy of elderly patients has increased dramatically worldwide, little information is available on the necessity of complete endoscopic stone removal in extremely elderly patients. This study aimed to evaluate the safety and efficacy of complete endoscopic stone removal in extremely elderly patients.
All extremely elderly patients (>90 years) who underwent endoscopic stone removal for choledocholithiasis at our hospital between January 2012 and January 2017 were retrospectively evaluated. The included patients were divided into complete stone removal and incomplete stone removal groups. Complication rate, overall survival (OS), and disease-specific survival (DSS) rates were compared between the two groups.
Overall, 73 patients were included in this study. The median number of stones was one (range, 0-10) and two (range, 1-12) ( = 0.043), while the median diameter of the largest stones was 9 (range, 0-27) and 14 (range, 5-46) mm ( = 0.001) in the complete and incomplete stone removal groups, respectively. During the follow-up period, OS was 60% and 39% and DSS was 95% and 97% in the complete and incomplete stone removal groups, respectively. Kaplan-Meier analysis found no significant difference in OS and DSS between the two groups ( = 0.052 and = 0.646, respectively).
Complete stone removal might not always be necessary in extremely elderly patients aged ≥90 years.
内镜下取石存在一些并发症。尽管全球老年患者的预期寿命已大幅提高，但关于极高龄患者完全内镜下取石必要性的信息却很少。本研究旨在评估极高龄患者完全内镜下取石的安全性和有效性。
对2012年1月至2017年1月在我院接受内镜下胆总管结石取石术的所有极高龄患者（>90岁）进行回顾性评估。纳入的患者分为结石完全清除组和不完全清除组。比较两组的并发症发生率、总生存率（OS）和疾病特异性生存率（DSS）。
本研究共纳入73例患者。结石完全清除组和不完全清除组的结石中位数分别为1个（范围0 - 10个）和2个（范围1 - 12个）（P = 0.043），最大结石的中位数直径分别为9 mm（范围0 - 27 mm）和14 mm（范围5 - 46 mm）（P = 0.001）。随访期间，结石完全清除组和不完全清除组的OS分别为60%和39%，DSS分别为95%和97%。Kaplan-Meier分析发现两组的OS和DSS无显著差异（分别为P = 0.052和P = 0.646）。
对于年龄≥90岁的极高龄患者，可能并非总是需要完全清除结石。
