急性胆管炎合并胆总管结石高龄患者行急诊ERCP治疗的安全性及有效性

摘要

Objective To investigate the efficacy and safety of emergency endoscopic retrograde cholan-giopancreatography (ERCP) in elderly patients with acute cholangitis. Methods From Jan. 2011 to Dec. 2015, emergency ERCPs were performed in 186 cases with acute cholangitis at Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. Patients were classified as elderly group if they were aged≥80 years (n=96), and patients in control group were aged < 65 years (n=90). The patients' medical records were retrospectively reviewed for comorbidities, details of the ERCP (therapeutic approaches, technical success rates, procedure duration), ERCP-related complications and mortality. Results The frequency of comorbidities was higher in the elderly group than that in the control group (87.5% vs 51.11%, P<0.05). Between two groups, there was no significant difference in the technical success rates (94.79% vs 95.56%, P>0.05). The complication rates (7.29% vs 5.56%, P>0.05) were not significantly different between the two groups. There was no significant dif-ference between the two groups regarding the complications rates such as pancreatitis, hemorrhage, perforation and infection (P>0.05). Surgical intervention was required in no case with ERCP-related complications. There was no mortality during the observational periods. Conclusion The emergency ERCP is safe and effective for elderly patients with acute cholangitis caused by common bile duct stones, but adverse events related to chronic concomitant diseases still need early detection and proper management. Elderly patients with complications are often more serious, and perioperative management should be strengthened.%目的 探讨急性胆管炎高龄患者行急诊ERCP治疗的安全性及有效性.方法 回顾性分析上海中医药大学附属普陀医院2011年1月至2015年12月因急性胆管炎合并胆总管结石行急诊ERCP的患者186例病例资料.其中,年龄≥80岁者96例,作为观察组;年龄<65岁者90例,作为对照组.分析两组的一般资料、合并症、治疗结果 及是否存在并发症等信息.结果观察组中合并症的发生率明显高于对照组(87.50%vs 51.11%,P<0.05).两组病例中,ERCP插管成功率无统计学差异(94.79%vs 95.56%,P>0.05).对照组无终止操作病例,观察组有2例患者因心肺功能抑制而终止操作.两组病例中ERCP术后相关并发症发生率的比较无统计学差异(7.29%vs 5.56%,P>0.05),胰腺炎、出血、穿孔及感染发生率的比较组间差异均无统计学意义(P均>0.05).所有并发症均未进行外科手术干预.两组病例中无ERCP相关死亡病例的发生.结论 急诊ERCP可安全有效地用于急性胆管炎合并胆总管结石的高龄患者,但需密切关注合并症,并及早发现可能引起的不良事件.高龄患者如发生并发症往往较严重,应加强围手术期的管理.