老年人内窥镜下逆行胰胆管造影及相关治疗方法的安全性分析

Safety analysis of endoscopic retrograde cholangiopanereatography and its associated treatments in the elderly

目的观察老年人内窥镜下逆行胰胆管造影(ERCP)的安全性.并分析导致术后并发症的相关因素。方法回顾性纳入2013年1月至2019年1月在北京大学人民医院消化内科就诊且行ERCP的患者512例。收集患者的基线临床资料.ERCP术后和术后并发症情况。比较老年组(≥65岁,301例)与非老年组(211例)基础疾病、手术操作与术后并发症的差异,并分析其相关性。结果老年组并存高血压.糖尿病、心脏病、乳头旁憩室比例高于非老年组(均P<0.01);胆石症、胆系手术史、ERCP史、免疫病、肿瘤两组比较,差异无统计学意义(均P>0.05);老年组患者术前应用抗凝、抗血小板药物的比例高于非老年组(均P<0.01)。内镜下乳头括约肌切开术是两组患者中最常见的ERCP术中操作.其他为内镜下乳头球囊扩张术、内镜下胆管支架引流术、胰管插管、胰管支架置入。老年组患者内镜下乳头球囊扩张术、内镜下胆管支架引流术比例为34.6%(104例)和18.9%(57例).高于非老年组患者的25.6%(54例)和11.4%(24例).差异有统计学意义(均P<0.05)。老年组患者胆总管直径和最大结石直径为(1.32±0.43)em.(1.04±0.53)em.大于非老年组患者的(1.16±0.40)cm.(0.81±0.03)cm.差异有统计学意义(t分别为-4.23,-4.76.均P<0.01);内镜下乳头球囊扩张术(P<0.05).胆管支架引流术(P<0.05)的操作比例明显高于非老年组患者。老年组和非老年组患者术中出血发生率分别为4.0%(12例)和5.7%(12例),差异无统计学意义(χ^(2)=0.08.P>0.05)。ERCP术后胰腺炎、出血、穿孔、感染、造影剂相关并发症发生率差异无统计学意义(均P>0.05)。结论老年患者ERCP中高风险的内镜下乳头球囊扩张术、内镜下胆管支架引流术操作多。但不增加老年人术中出血和术后并发症.对老年人ERCP是一项安全的手术操作。

Objective To investigate the safety of endoscopic retrograde cholangiopancreatogra phy(ERCP)and its associated treatments in the elderly aged 65 years and over,and analyze the related factors leading to postoperative complications.Methods Totally 512 patients who received ERCP and its associated treatments in the Department of Gastroenterology.Peking University People's Hospital from January 2013 to January 2019 were included retrospectively.The climical data.operative procedures and postoperative complications were collected.The differences in underlying diseases.operative procedures and postoperative complications between the elderly group(≥65 years old.n=301)and the non elderly group(n=211)were compared,and the correlations between them were analyzed.Results The proportion of hypertension.diabetes.heart disease and diverticulum beside the nipple was higher in the elderly group than in the non-elderly group(all P<0.01).The proportion of preoperative medication of anticoagulant and antiplatelet drugs was higher in the elderly group than in the non-elderly group(all P<0.01).There were no significant differences in cholelithiasis,history of biliary surgery,history of ERCP,immunity disease and tumor between the two groups(all P>0.05).Endoscopic sphincterotomy was the most common ERCP associated treatments in both groups.followed by the order of endoscopie bllo dilation of the nipple.endoscopie biliary stent drainage.pancreatic duct intubation.and pancreatic duct stenting.The proportions of endoscopic papillary balloon dilation and endoscopie biliary stent drainage were 34.6%(104 cases)and 18.9%(57 cases)respectively.in the elderly group.which were statistically significantly higher than 25.6%(54 cases)and 11.4%(24 cases)in the nonrelderly group(all P<0.05).The common bile duct diameter and maximum stone diameter were(1.32±0.43)cm and(1.04±0.53)cm.respectively in the elderly group.which were statistically significantly higher than those in the non elderly group(1.16±0.40)cm.and(0.81±0.03)cm respectively.(t values were-4.23 and-4.76.respectively.all P<0.01).The proportions of endoscopie papillary balloon dilation and biliary stent drainage were statistically significantly higher in elderly patients than in non-elderly patients(all P<0.05).The incidence of intraoperative bleeding was 4.0%(12 cases)and 5.7%(12 cases)in the elderly group and non elderly group,respectively,with no statistical significance(χ^(2)=0.08.P>0.05).There was no significant difference in the incidence of postoperative pancreatitis.bleeding.perforation.infection and contrast agent-related complications(all P>0.05).Conclusions Clinically widely used high-risk endoscopic papillary balloon dilation and endoscopie biliary stent drainage(ERCP-associated treatments)are frequently performed in elderly patients.and do not increase int raoperative bleeding and postoperative complications in the elderly.Therefore.ERCP associated lreatments are safe for the elderly.