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老年患者与年轻患者内镜逆行胰胆管造影术(ERCP)结果及并发症风险的比较:一项大型单中心研究

Comparison of ERCP Outcomes and Complication Risk between Elderly and Younger Patients: A Large Single-Center Study.

作者信息

Cagir Yavuz, Durak Muhammed Bahaddin, Simsek Cem, Yuksel Ilhami

机构信息

Department of Gastroenterology, Ankara Bilkent City Hospital, Ankara 06800, Turkey.

Department of Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara 06230, Turkey.

出版信息

J Clin Med. 2024 Oct 14;13(20):6112. doi: 10.3390/jcm13206112.

Abstract

The current study compared potential risks, complications, and the impact on clinical outcomes among elderly and younger patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Procedure-related complications, risk factors, and clinical outcomes following complications in elderly patients (aged ≥75 years) and younger who underwent biliary ERCP were evaluated. Median age of 63 (48-74) of 1164 patients who underwent biliary ERCP for the first time, and 266 (22.8%) were elderly. Comorbidities were statistically significant (81 [30.5%] versus 78 [8.7%], < 0.001), and periampullary diverticulum (PAD) was detected more commonly in the elderly group (79 [29.7%] vs. 103 [11.5%], < 0.001). There was no statistical difference in cannulation technique, cannulation time, and cannulation success in both groups, while the total ERCP procedure time was higher in the elderly group (22 [16-29] vs. 20 [14-29], = 0.030). Regarding the procedure-related complications, there was no statistically significant difference between the two groups (26 [9.8%] vs. 71 [7.9%], = 0.292). In the case of complications, the length of hospitalization stay was statistically longer in the elderly group. Moreover, the elderly had a longer length of hospitalization, experiencing pancreatitis and a higher probability of developing moderate/severe pancreatitis. In multivariate and univariate analysis, prolonged cannulation time was found to be an independent risk factor in patients ≥75 years of age. This study showed that while ERCP-related complication rates in elderly patients are comparable to younger patients, it can be associated with worse outcomes following the complication and prolonged length of hospitalization.

摘要

本研究比较了接受内镜逆行胰胆管造影术(ERCP)的老年患者和年轻患者的潜在风险、并发症以及对临床结局的影响。评估了老年患者(年龄≥75岁)和接受胆管ERCP的年轻患者的手术相关并发症、风险因素及并发症后的临床结局。1164例首次接受胆管ERCP的患者的中位年龄为63岁(48 - 74岁),其中266例(22.8%)为老年患者。合并症具有统计学意义(81例[30.5%]对78例[8.7%],<0.001),且老年组壶腹周围憩室(PAD)的检出率更高(79例[29.7%]对103例[11.5%],<0.001)。两组在插管技术、插管时间和插管成功率方面无统计学差异,而老年组的ERCP总手术时间更长(22分钟[16 - 29分钟]对20分钟[14 - 29分钟],P = 0.030)。关于手术相关并发症,两组之间无统计学差异(26例[9.8%]对71例[7.9%],P = 0.292)。发生并发症时,老年组的住院时间在统计学上更长。此外,老年患者住院时间更长,发生胰腺炎的概率更高,且发生中度/重度胰腺炎的可能性更大。在多因素和单因素分析中,发现插管时间延长是75岁及以上患者的独立危险因素。本研究表明,虽然老年患者ERCP相关并发症发生率与年轻患者相当,但并发症后的结局可能更差,住院时间更长。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eeef/11508533/3ea2223ce9fe/jcm-13-06112-g001.jpg

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