Himal H S
Department of Surgery, Toronto Hospital, Ont.
Can J Surg. 1996 Jun;39(3):225-8.
To study the long-term effects of endoscopic sphincterotomy alone in elderly patients with choledocholithiasis and cholelithiasis.
A chart review.
A university-affiliated hospital.
Twenty-one patients over 60 years of age, who presented with cholecystitis, jaundice or cholangitis. The follow-up ranged from 1 to 5 years (mean 3.51 years).
Endoscopic sphincterotomy.
The occurrence of postsphincterotomy pancreatitis, cholangitis and cholecystitis.
In the early postsphincterotomy period, 3 of the 21 patients had pancreatitis, which was treated conservatively. One patient had cholangitis. In this patient the initial sphincterotomy did not clear the common bile duct of all stones, but a repeat procedure was successful and the cholangitis resolved. One patient had mild cholecystitis that responded to conservative therapy. In the long term, 9 of the 21 patients had cholecystitis. This was treated conservatively in six patients, but three required cholecystectomy. One patient had choledocholithiasis requiring exploration of the common bile duct.
In elderly debilitated patients with cholelithiasis and choledocholithiasis, endoscopic sphincterotomy alone may be adequate therapy. However, patients presenting with cholangitis and cholelithiasis may eventually require cholecystectomy.
研究单纯内镜下括约肌切开术对老年胆总管结石和胆囊结石患者的长期影响。
病历回顾。
一所大学附属医院。
21例60岁以上出现胆囊炎、黄疸或胆管炎的患者。随访时间为1至5年（平均3.51年）。
内镜下括约肌切开术。
括约肌切开术后胰腺炎、胆管炎和胆囊炎的发生情况。
在括约肌切开术后早期，21例患者中有3例发生胰腺炎，经保守治疗。1例患者发生胆管炎。该患者最初的括约肌切开术未能清除胆总管内所有结石，但再次手术成功，胆管炎得以缓解。1例患者发生轻度胆囊炎，经保守治疗有效。长期来看，21例患者中有9例发生胆囊炎。6例患者经保守治疗，3例需要行胆囊切除术。1例患者有胆总管结石，需要探查胆总管。
对于患有胆囊结石和胆总管结石的老年体弱患者，单纯内镜下括约肌切开术可能是足够的治疗方法。然而，出现胆管炎和胆囊结石的患者最终可能需要行胆囊切除术。
