内镜逆行胰胆管造影术用于老年胆总管结石效果及术后并发症的危险因素分析

Study on the effect of ERCP and risk factors of complications resulted from ERCP in elderly patients with choledocholithiasis

摘要:

目的 评价内镜逆行胰胆管造影术（ERCP）用于老年胆总管结石效果及并发胰腺和胆道感染的危险因素。方法 收集2019年3月－2020年5月入院行ERCP的300例老年胆总管结石患者的基本情况、临床资料和既往病史等，观察其治疗效果，并分析探讨术后并发症的危险因素。结果 300例老年胆总管结石患者经ERCP治疗后，取石成功率为97.33%，37例（12.33%）患者术后并发胰腺和胆道感染，其中术后胰腺炎（PEP）20例，胆道感染17例。经Logistic回归分析，肥胖［体重指数（BMI） > 28 kg/m²］、Oddi括约肌功能障碍（SOD）病史、多次插管、插管时间 > 60 min以及胰管显影为老年胆总管结石患者ERCP术后并发胰腺炎的危险因素；胆管结石病史、胆管治疗史以及胆管中高位梗阻为术后并发胆道感染的危险因素。结论 ERCP治疗老年胆总管结石疗效显著，需加强危险因素识别与评估，以减少并发症的发生。

Abstract:

Objective To analyze and evaluate the effect of ERCP and risk factors of complications resulted from ERCP in elderly patients with choledocholithiasis.Methods 300 elderly patients with choledocholithiasis were recruited from March 2019 to May 2020, whose clinical data were collected to analyze the effect of ERCP and risk factors of complications resulted from ERCP.Results 97.33% of the 300 patients had successfully completed ERCP, and complications such as post-ERCP pancreatitis (PEP) and infection of biliary tract occurred in 37 patients. Logistic regression showed that the risk factors for PEP were obesity (BMI > 28 kg/m²), sphincter of Oddi dysfunction, multiple cannulation, lengthy cannulation time ( > 60 min) and pancreatic duct imaging. The risk factors for infection of biliary tract were history of bile duct calculus, history of bile duct therapy, and high biliary tract obstruction.Conclusion ERCP in elderly patients with choledocholithiasis proved effective. Identification and evaluation of the risk factors should be taken to avoid complications resulted from ERCP.