高龄患者经内镜逆行胰胆管造影术的风险评价

Risk evaluation of endoscopic retrograde cholangiopancreatography for elder patients

目的评价高龄患者（年龄≥80岁）行经内镜逆行胰胆管造影术（ERCP）的安全性。方法收集南昌大学第一附属医院2008年6月至2014年6月行ERCP的80岁及以上患者464例为观察组，按1：4的比例，随机选取同期行ERCP的60岁及以下患者为对照组，比较两组患者疾病分布特点、合并症、ERCP术中情况及术后并发症。结果观察组患者合并冠心病、高血压、肺部慢性疾病、2型糖尿病的比例高于对照组（P〈0．05），但合并心律失常者较对照组差异无统计学意义（P=0．111）。两组患者疾病特点以胆总管结石为主，但在观察组中合并恶性肿瘤的比例大于对照组（P〈0．05）。观察组和对照组患者ERCP成功率差异无统计学意义（98．92％比99．35％，P=0．358），术后并发急性胰腺炎（4．96％比3．18％，P=0．064）、感染（0．43％比0．54％，P=1．000）、出血（1．08％比0．59％，P=0．259）差异无统计学意义，但穿孔发生率差异有统计学意义（0．43％比0．05％，P=0．043）。结论高龄患者行ERCP检查疗效显著，并且安全有效。

Objective To evaluate the safety of endoscopic retrograde cholangiopancreatography （ERCP） for elder patients （age more than or equal to 80 years）. Methods Data of 464 patients（ age ≥ 80 years） who underwent ERCP procedures from June 2008 to June 2014 in the First Affiliated Hospital of Nanchang University were compared with those of patients less than or equal to 60 years old, randomly chosen at 1：4, for comorbidity, feature of disease distribution, intraoperative situation and postoperative complications of ERCP. Results The comorbidity rates of coronary heart disease, hypertension, chronic pulmonary disease and type 2 diabetes in observation group were significantly higher than those in the control group （P〈0.05） , but there was no significant difference between two groups regarding to the eomorbidity rate of arrhythmia（ P= 0. 111 ）. The main feature of disease distribution in two groups was choledoeholithiasis, but the rate of malignant tumor in observation group was higher than that in the control group（P〈0.05）. The success rate of ERCP showed no significant difference in two groups （ 98.92% VS 99. 35%, P = 0. 358）. There was no significant difference between the two groups in the complication rates of acute pancreatitis （4. 96% VS 3.18%, P = 0. 064）, infection （0. 43% VS 0. 54%, P = 1. 000） and hemorrhage （ 1.08% VS 0. 59%, P= 0. 259）. However the rate of perforation in observation group was lower than that in the control group （ 0. 43% VS 0. 05%, P = 0. 043）. Conclusion ERCP is safe and effective for elder patients.