超高龄胆胰壶腹周围疾病行治疗性内镜逆行胰胆管造影的临床特征分析

Clinical characteristics of ultra-elderly patients with biliary pancreatic periampullary disease treated with endoscopic retrograde cholangiopancreatography

目的探讨超高龄胆胰壶腹周围病变行内镜逆行胰胆管造影(ERCP)治疗的可行性及患者的临床特征。方法回顾性分析2014年5月至2018年5月川北医学院附属医院收治的307例行ERCP治疗的患者临床资料。根据患者年龄分为超高龄组(≥80岁)和非超高龄组(<80岁),探讨两组患者的临床特征。结果 92例超高龄组患者年龄(85.29±7.32)岁,215例非超高龄组患者年龄(57.81±14.26)岁。超高龄组患者原发病以壶腹部癌为主(P<0.01),ASAⅢ、Ⅳ级患者以及合并高血压、冠心病、糖尿病、慢性阻塞性肺疾病、十二指肠乳头旁憩室的比例明显高于非超高龄组(P<0.05)。超高龄组支架植入指征为胆管恶性狭窄以及采取支架植入或更换的患者比例明显更高(P=0.023、<0.001),而胆总管结石内镜取石比例更低(P=0.005),术后出血的发生率明显升高(P=0.021)。单因素分析显示原发疾病为壶腹部癌(P=0.044),合并十二指肠乳头旁憩室(P<0.001)、高血压(P=0.022)及冠心病(P=0.012),内镜下乳头括约肌切开术进行十二指肠乳头处理(P=0.012)为ERCP术后出血的危险因素。结论超高龄胆胰壶腹周围病变患者恶性疾病患病率高、合并疾病多,但并非治疗性ERCP术的绝对禁忌证,临床需防范术后出血的风险。

Objective To investigate the clinical characteristics of ultra-elderly patients with biliary pancreatic periampullary disease treated with endoscopic retrograde cholangiopancreatography(ERCP). Methods The clinical data of three hundred and seven patients with ERCP treated in the Affiliated Hospital of North Sichuan Medical College were analyzed retrospectively. According to the age,the patients were divided into the ultra-elderly group(aged over 80 years) and the control group(aged under 80 years), and the clinical characteristics were explored. Results The average age of 92 patients in the ultra-elderly group was(85.29±7.32) years, and that of 215 patients in the control group was(57.81±14.26)years. The primary disease of the ultra-elderly group was ampullary cancer(P<0.01). The proportions of ASA grade and, hypertension, coronary heart disease, diabetes mellitus, chronic obstructive pulmonary disease and duodenal diverticulum in the ultra-elderly group were significantly higher than that in the control group(P<0.05). The proportion of patients with malignant biliary stricture and stent implantation or replacement in the ultra-elderly group was significantly higher(P=0.023,<0.001), while the proportion of patients with choledocholithiasis was lower(P=0.005), and the incidence of postoperative bleeding was significantly higher(P=0.021). Univariate analysis showed that malignant obstructive jaundice as the primary disease(P=0.044), accompanied by duodenal diverticulum(P<0.001), hypertension(P=0.022)and coronary heart disease(P=0.012), endoscopic sphincterotomy for treatment of duodenal papillae(P=0.012) were risk factors for postoperative bleeding after ERCP. Conclusions Periampullary malignant diseases of gallbladder, pancreas and ampulla have a high incidence in the ultra-elderly patients with many complications, but they are not absolute contraindication of therapeutic ERCP. The risk of bleeding after operation should be prevented clinically.