老年患者行ERCP后的风险性及危险因素分析

目的 研究老年患者行ERCP后的风险性，进而分析其可能的危险因素。方法 选取2015年1月~2017年1月于笔者医院行ERCP的年龄≥60岁的患者79例作为研究对象。ERCP结束后对患者进行为期30天的随访，根据患者术后30天内是否出现并发症对患者进行分组，未出现并发症为预后良好组，出现并发症为预后不良组。分析患者预后不良率，并应用单因素分析及多因素COX回归确定其影响因素。结果 患者术后并发症的发生率为8.97%，并发症主要有术后胰腺炎、胆管感染、消化道大出血、穿孔。单因素分析显示：胰管括约肌切开、乳头括约肌切开、导丝进入胰管、胰管造影对患者预后有影响（P<0.05），多因素COX回归分析显示：乳头括约肌切开术、导丝进入胰管对老年患者ERCP预后存在明显影响（P<0.05），其中乳头括约肌切开对患者预后影响较大且高于导丝进入胰管（RR=3.159 vs RR=1.402）。结论 老年患者行ERCP治疗预后较好，乳头括约肌切开术、导丝进入胰管是影响老年患者ERCP预后的独立危险因素。

Analysis of the Risk of ERCP in Aged Patients and Its Risk Factors

Objective To study the risk of ERCP in aged patients and to analyze its risk factors. Methods Totally 79 patients accepted ERCP from January 2015 to January 2017 whose age are greater than 60 years were selected as the study subjects. The patients were followed up for 30 days after ERCP, and the patients were divided according to whether the complications occurred within 30 days after operation. The patients who did not have the complication were defined as the favorable prognosis group and the rest were poor prognosis group. The prognosis of the patients was analyzed. The prognosis was analyzed and the risk factors were determined by univariate analysis and multivariate COX regression. Results The incidence of postoperative complications was 8.97%. The main complications were postoperative pancreatitis, biliary tract infection, gastrointestinal bleeding and perforation. Univariate analysis showed that pancreatic duct sphincter incision, papillary sphincter incision, the entrance of the guidewire into the pancreatic duct and pancreatic angiography had an effect on the prognosis of the aged patients after ERCP (P<0.05).Multivariate COX regression showed that papillary sphincter incision (RR=3.159, P<0.05) and the entrance of the guidewire into the pancreatic duct (RR=1.402,P<0.05) had a significant effect on the prognosis of the aged patients after ERCP, and papillary sphincter incision had a greater effect on patients than the entrance of the guidewire into the pancreatic duct (RR=3.159 vs RR=1.402). Conclusion The prognosis of aged patients after ERCP is favorable, and papillary sphincter incision and the entrance of the guidewire into the pancreatic duct are independent risk factors that have an effect on the prognosis of the aged patients after ERCP.