治疗性ERCP应用于90岁以上高龄患者的安全性及有效性分析

背景我国已步入老龄化国家行列,高龄胆胰疾病患者逐年增多,这些患者大多无法耐受外科手术或无手术机会,内镜逆行胰胆管造影术(ERCP)成为其首选治疗方案。目的评价治疗性ERCP应用于90岁及以上高龄患者的安全性及有效性。方法回顾性分析东方肝胆外科医院内镜科2000年1月1日至2012年1月1日接受ERCP治疗且年龄≥90岁患者(观察组49例共53例次)的临床资料,按操作顺序选择每例患者之后连续4例符合匹配条件的患者作为对照(对照组198例共212例次),比较两组间ERCP操作的完成情况、并发症发生率及其严重程度。结果两组间操作成功率无显著差异(观察组45/53,对照组191/212,P=0.279);观察组有3例次因合并症终止操作,对照组无终止操作病例,两组间有显著差异(P=0.008);观察组并发症总发生率为9.43%,略高于对照组的8.49%(P=0.503),胰腺炎、出血、胆管炎发生率组间差异均无统计学意义(P值均>0.05),但观察组发生并发症患者中,中重度比例明显较对照组高(观察组4/53,对照组1/212,P=0.006),两组均无穿孔、死亡病例。结论治疗性ERCP可安全有效地用于90岁以上高龄患者,但应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,应加强术前术后管理。

Safety and efficacy of therapeutic ERCP for patients over 90 years of age

Background Elderly patients with biliopancreatic disease increase year by year in China, therapeutic ERCP is the optimization treatment for them, because most of them can not endure surgery or lose the opportunity of operation. Aims To evaluate the safety and efficacy of therapeutic ERCP for patients over 90 years of age. Methods The data of 49 patients of over 90 years of age who underwent 53 ERCP procedures from January 2000 to January 2012 were studied retrospectively and compared with those of 198 matched patients（212 procedures） under 60 years old at a 1：4 ratio for success rate and complication. Results The rate of success in observation group was 84.91% （45/53）, which was similar with 90.09% （191/212） in control group （P=0.279）. The rate of terminated operation in observation group （5.66% , 3/53） was significantly higher than that of the control group （0.00%, 0, P=0.008）. The overall rate of complication in observation group was 9.43% , slightly higher than that of the control group 8.49%（P=0.503）. There was no significant difference between the two groups regarding the rates of such complications as pancreatitis, hemorrhage and infection（all P0.05）, but the moderate and severe complications in observation group（7.55% , 4/53） was significantly higher than that of the control group（0.47%, 1/212, P=0.006）. No perforation or death was observed. Conclusion Therapeutic ERCP for patients of 90 years or older is safe and effective, but adverse events related to chronic concomitant diseases need early detection and proper management. Severe complications in elderly may develop more frequently, therefore, the proactive administration before and after the ERCP procedure is warranted.