中国临床药学杂志

目的 分析熊去氧胆酸（UDCA）联合经内镜逆行胆胰管成像（ERCP）治疗老年患者复杂胆管结石的疗效，为临床提供参考。方法 选取2020年1月至2023年4月收治的复杂胆管结石老年患者64例，随机分为观察组和对照组各32例，对照组予常规ERCP下胆管内支架置入术，并取出胆结石，观察组在对照组基础上予UDCA治疗2个月，第1次ERCP后3～6个月行第2次ERCP，移除支架并再次取出胆结石。记录第1次ERCP取石的最大结石直径和数量，以及第2次ERCP取石的最大结石直径、数量、成功率和结石取出时间。比较2组治疗前和2次ERCP后肝功能指标[碱性磷酸酶（AKP）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、谷氨酰转肽酶（GGT）、总胆红素（TBIL）、直接胆红素（DBIL）、总胆汁酸（TBA）和结合胆红素（CB）]水平；比较2组症状改善情况，以及胃肠道生活质量（GIQLI）评分和并发症发生情况。结果 2组第1次ERCP取石的最大结石直径和数量比较差异无统计学意义（P> 0.05）；观察组第2次ERCP的最大结石直径小于对照组，取石数量少于对照组，取石成功率高于对照组，结石取出时间短于对照组，差异均有统计学意义（P <0.05）；观察组第2次ERCP后6个月内胆绞痛、发热、腹胀和腹痛症状消失占比高于对照组（P <0.05）；第1次ERCP后，2组肝功能指标水平均低于治疗前（P <0.01），第2次ERCP后，2组肝功能指标水平低于治疗前和第1次ERCP后（P <0.01），并且观察组明显低于对照组（P <0.01）；第2次ERCP后2组GIQLI评分均高于治疗前和第1次ERCP后（P <0.01），并且观察组GIQLI评分高于对照组（P <0.01）;2组并发症总发生率比较差异无统计学意义（P> 0.05）。结论 UDCA联合ERCP可提高老年复杂胆管结石患者的疗效，缓解临床症状，改善肝功能和生活质量，有利于提高后续取石成功率，并且安全性良好，值得临床推广。

AIM To analyze the effect of ursodeoxycholic acid(UDCA) combined with endoscopic retrograde cholangiopancreatography(ERCP) in treating complex cholangiolithiasis in elderly patients, and to provide reference for clinical treatment. METHODS A total of 64 elderly patients with complex cholangiolithiasis admitted to the hospital from January 2020 to April 2023 were prospectively selected and randomly divided into observation group(32patients) and control group(32 patients). The control group was given conventional ERCP and biliary stent placement,and gallstones were also removed. The observation group was given UDCA treatment for 2 months in addition to the treatment of the control group. The second ERCP was performed between 3 and 6 months after the first ERCP, during which the stent was removed and gallstones were retaken. The maximums stone diameter and the number of stones removed during the first ERCP procedure, as well as the maximum stone diameter, the number of stones removed, the success rate, and the stone extraction time during the second ERCP procedure were all recorded. Levels of liver function indicators [alkaline phosphatase(AKP), alanine aminotransferase(ALT), aspartate aminotransferase(AST), gammaglutamyl transpeptidase(GGT), total bilirubin(TBIL), direct bilirubin(DBIL), total bile acids(TBA), and conjugated bilirubin(CB)] were compared between 2 groups before treatment and after twice ERCP procedures. Additionally, the improvement in symptoms, gastrointestinal quality of life index(GIQLI) scores, and the incidence of complications after twice ERCP procedure were assessed and compared between 2 groups. RESULTS There were no significant differences in the maximum stone diameter and number of stones between 2 groups(P > 0.05). The maximum stone diameter and the number of stones in the observation group were smaller than those in the control group at the second time of ERCP extraction, the success rate of stone extraction was higher than that in the control group, and the time of stone extraction was shorter than that in the control group, with significant differences(P < 0.05). The disappearance rates of biliary colic,fever, abdominal distension and abdominal pain in the observation group were better than those in the control group(P <0.05). After the first ERCP, the liver function indexes of 2 groups were lower than those before treatment(P < 0.01). After the second ERCP, the liver function indexes of 2 groups were lower than those before treatment and after the first ERCP(P < 0.01), and the observation group was significantly lower than the control group(P < 0.01). The GIQLI scores of 2 groups after the second ERCP were higher than those before treatment and after the first ERCP(P < 0.01), and the GIQLI score of the observation group was higher than that of the control group(P < 0.01). The GIQLI score of the observation group was higher than that of the control group after the second ERCP removal(P < 0.05). There was no significant difference in the total incidence of complications between 2 groups(P > 0.05). CONCLUSION The UDCA combined with ERCP can enhance the therapeutic outcomes for elderly patients with complex cholangiolithiasis, alleviate clinical symptoms,improve liver function and quality of life, and favorably impact the success rate of subsequent stone extraction. It also demonstrates good safety, making it worthy of clinical promotion.