老年人的内镜逆行胰胆管造影术：一项前瞻性比较研究。

Endoscopic retrograde cholangiopancreatography in the elderly: a prospective and comparative study.

作者信息

Köklü Seyfettin, Parlak Erkan, Yüksel Osman, Sahin Burhan

机构信息

Department of Gastroenterology, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey.

出版信息

Age Ageing. 2005 Nov;34(6):572-7. doi: 10.1093/ageing/afi180.

DOI:10.1093/ageing/afi180

PMID:16267181

Abstract

OBJECTIVE

In this study we aimed to compare the utility and safety of endoscopic retrograde cholangiopancreatography (ERCP) in elderly and younger groups of people.

METHODS

The study involved 299 patients who underwent ERCP for the first time between March 2002 and January 2003. Group A consisted of 202 patients who were 69 years of age or younger and group B involved 97 patients who were 70 years of age or older. The patients were prospectively identified and data were gathered on them prospectively. Clinical and biochemical features, ERCP procedures, ERCP diagnosis, complications and length of hospital stay were compared between the two groups.

RESULTS

Group B patients presented with more specific symptoms compared with group A. Laboratory findings were similar in both groups other than mean bilirubin levels, which were higher in the elderly group. Selective biliary cannulation was technically successful in 99% of both groups. Pre-cut papillotomy was performed in 49.5% of group A patients and 56.7% of group B patients. Choledocholithiasis was the most frequent diagnosis in both groups. Benign biliary stenosis was more frequent in group A and malignant biliary stenosis in group B. Among the malignant aetiologies, pancreatic carcinoma was the most common cancer in both groups. Post-procedural complications developed in 27 (9%) patients. There were 16 (7.9%) complications (six bleeding, five pancreatitis, three perforation and two cholangitis) in the 202 patients aged under 70 years. In comparison, 11 (11.3%) of the 97 patients aged over 70 years developed a complication (bleeding in six, pancreatitis in one, perforation in one, cholangitis in two and ileus in one). Twelve (nine group A and three group B) patients died within 5-30 days of the procedure. Length of hospital stay was comparable for both groups (15.53+/-12.43 days in group A and 14.84+/-11.56 days in group B).

CONCLUSIONS

Diagnostic and therapeutic ERCP has similar outcomes in both elderly and younger patients. ERCP is effective and safe in elderly patients with naive papilla. The more invasive procedures like pre-cut papillotomy may be performed safely in the elderly.

摘要

目的

在本研究中，我们旨在比较内镜逆行胰胆管造影术（ERCP）在老年人群和年轻人群中的效用及安全性。

方法

该研究纳入了2002年3月至2003年1月期间首次接受ERCP的299例患者。A组由202例69岁及以下的患者组成，B组包括97例70岁及以上的患者。对患者进行前瞻性识别并前瞻性收集他们的数据。比较两组患者的临床和生化特征、ERCP操作、ERCP诊断、并发症及住院时间。

结果

与A组相比，B组患者表现出更具特异性的症状。除平均胆红素水平外，两组的实验室检查结果相似，老年组的平均胆红素水平更高。两组中99%的患者选择性胆管插管技术成功。A组49.5%的患者和B组56.7%的患者进行了预切开乳头切开术。胆总管结石是两组中最常见的诊断。良性胆管狭窄在A组中更常见，恶性胆管狭窄在B组中更常见。在恶性病因中，胰腺癌是两组中最常见的癌症。术后有27例（9%）患者发生并发症。202例70岁以下患者中有16例（7.9%）发生并发症（6例出血、5例胰腺炎、3例穿孔和2例胆管炎）。相比之下，97例70岁以上患者中有11例（11.3%）发生并发症（6例出血、1例胰腺炎、1例穿孔、2例胆管炎和1例肠梗阻）。12例（A组9例和B组3例）患者在术后5 - 30天内死亡。两组的住院时间相当（A组为15.53±12.43天，B组为14.84±11.56天）。