高龄老人内镜逆行胰胆管造影诊疗安全性评价

Safety evaluation of endoscopic retrograde cholangiopancreatography for elderly patients

摘要:

目的 探讨高龄老人（>80 岁）经内镜逆行胰胆管造影（ERCP）诊疗的安全性。方法 回顾性 分析80 例实施ERCP 诊治的80 岁以上老年患者，评估既往疾病谱对ERCP 操作的影响并进行相应干预，在 尽可能短的时间内完成ERCP 操作，术后围手术期严格管理，检测血常规、血尿淀粉酶及必要生化指标，1 周 内检测有无继发或加重其他脏器损伤。结果 80 例80 岁以上患者中11 例（13.75%）合并重要脏器疾病，2 种以上疾病者占51.25%（41/80）。77 例（96.25%）顺利完成内镜下治疗，一次取石成功率为74.55%（41/55）， 3 例无法行二次取石患者内镜下将鼻胆引流管剪断改为内引流；1 例胰腺癌并十二指肠狭窄患者先行狭窄 肠腔扩张后ERCP 置入胆道金属支架，后行十二指肠支架置入。80 例患者中1 例胰腺癌并胆总管结石患者 ERCP 行胆道金属支架置入后1 周继发肾衰，死于心衰、呼吸衰竭；无其他严重并发症发生，总的并发症发 生率为7.50%，ERCP 平均操作时间为（26.64±8.31）min。结论 高龄老人（>80 岁）行ERCP 操作相对比 较安全，术后效果明显，围手术期全程进行管理，可降低并发症发生。

Abstract:

Objective To evaluated the security of endoscopic retrograde cholangiopancreatography (ERCP) among the patients aged over 80 years. Methods 80 patients who were accepted ERCP and aged over 80 years were analgzed, to learn the diseases of patients and evaluate what the impact of ERCP. To complete ERCP in the shortest time, we observed of vital signs, abdominal symptoms and nasal biliary drainage rigorouly after the opration , and to test blood routine, serum amylase, urine amylase and biochemical indicators, detect whether secondary or aggravate other organs damage within 1 week. Results There were 11 cases (13.75%) had secondary organs damage, the percentage of with over two diseases is 51.25%, 78 cases (96.25%) accepted the ERCP, the primary success rate of lithotomy in 55 cases of common bile duct stones is 74.55%, among them there were 3 cases accepted internal drainage by cutting the nasobiliary since they can not be conducted lithotomy once more. One patient of pancreatic carcinoma complicated with duodenal stenosis was treated in implantation of biliary metal stent after accepted the dilation of bile duct , and then the stent was implanted in the narrow duodenum. One patient was died of heart failure, renal failure and respiratory failure after one week; There were no other serious complications occurred, the total incidence rate of complication was 7.50%, the average operation time was (26.64 ± 8.31) min. Conclusions The patients over 80 years old are relatively safe for ERCP, the effect is obviously, and appropriate management of perioperative can reduce the incidence of complications.