摘要
背景:本研究旨在评估内镜逆行胆胰管造影术(ERCP)、ERCP+胆囊切除术(EC)和经皮抽吸术(PA)三种方法治疗老年胆总管结石患者的疗效。方法:研究纳入43,338例老年(≥60岁)和45,295例年龄<60岁的胆总管结石病例。病例来自美国全国住院样本库2011-2014年间因胆石并发症入院的病例,其诊断基于ICD 9。采用多因素逻辑回归模型计算住院死亡的风险,并比较各治疗组(ERCP、EC、PA)、各年龄组(<60岁、60-69岁、70-79岁、≥80岁)及性别组的差异。采用单变量线性回归模型比较各年龄组间住院时间和再入院频率的差异。结果:在排除治疗方式的影响后,患者年龄会影响病死率和住院时间。在各个年龄组中,PA组均有最高的死亡风险和最长的住院时间,而EC组病死率最低,ERCP组住院时间最短。年龄和治疗方式均不影响再住院率。性别不影响病死率和再住院率。然而,在60-69岁的患者中,女性住院时间更短。结论:患者年龄越大,胆总管结石及其相关并发症的治疗效果越差。无论是什么年龄段的胆石症患者,胆囊切除术可能都是一种有效的治疗方法。
Objective:The aim of this study was to evaluate the differences in clinical outcomes of endoscopic retrograde cholangiopancreatography(ERCP),ERCP followed by cholecystectomy(EC)and percutaneous aspiration(PA)in the elderly population with choledocholithiasis.Methods:We included a total of 43338 elderly patients aged 60 years or older and 45295 patients younger than 60 years for comparison in our study.Data were obtained from the Nationwide Inpatient Sample(Healthcare Utilization Project)for years 2001–14 by identifying patients who were admitted for gallstone complications based on the ICD 9 diagnostic code.Multiple logistic regression was used to calculate the odds of in-hospital mortality and to detect statistical differences among the treatment groups,age groups and between male and female patients.Univariate ordinary linear regression was used to compare the length of hospital stay and readmission frequency among the different age groups.Results:The age of the patient affected mortality and the length of hospital stay after any type of procedure of gallstones removal.In a manner independent of the patient’s age,PA was associated with the highest risk of death and length of stay,while the EC was characterized by lowest mortality and ERCP by the shortest length of stay.Neither age of the patient nor the type of procedure affected the likelihood of readmission.The odds of death and the probability of readmission were not affected by patient sex.However,in patients aged between 60 and 79 years,the female gender predicted a shorter duration of stay in the hospital.Conclusions:A patient’s age negatively affects the treatment outcomes of cholelithiasis with associated complications.The EC procedure appears to be the method of choice for the management of complicated gallstones in patients of all ages.
