内镜逆行胰胆管造影术治疗超高龄胆总管结石患者的有效性和安全性分析

Effectiveness and safety of endoscopic retrograde cholangiopancreatography for the treatment of super-older patients with calculus of common bile duct

摘要:

目的 探讨内镜逆行胰胆管造影术（ERCP）应用于超高龄（≥90岁）胆总管结石患者的安全性和有效性。方法 回顾性分析2011年1月－2023年12月于该院肝胆外科行ERCP治疗的年龄≥65岁的老年胆总管结石患者的临床资料，年龄≥90岁的患者为超高龄组，年龄≥65岁且 < 90岁的患者为非超高龄老年组。将两组患者的性别、结石数量、结石大小、胆囊结石、乳头周围憩室和胆总管插管等基线资料通过1∶1倾向评分匹配进行匹配，比较匹配后两组患者的手术成功率、结石取净率、并发症发生率和住院时间等指标。结果 共有428例老年胆总管结石患者纳入研究（超高龄组45例，非超高龄组383例），通过1∶1倾向评分匹配对基线资料进行匹配后，得到超高龄组44例和非超高龄组44例。超高龄组和非超高龄组的伴随基础疾病率比较，差异无统计学意义［81.82%（36/44）和65.91%（29/44），P=0.189］，但超高龄组脑卒中发生率［34.09%（15/44）和6.82%（3/44）］和ASA分级（Ⅲ级或Ⅳ级）［97.73%（43/44）和38.64%（17/44）］明显高于非超高龄组，差异有统计学意义（P < 0.01）。两组患者ERCP手术成功率［90.91%（40/44）和93.18%（41/44）］、结石取净率［65.91%（29/44）和81.82%（36/44）］、并发症总发生率［43.18%（19/44）和27.27%（12/44）］和中位住院时间（15.00和14.50 d）比较，差异均无统计学意义（P > 0.05）。结论 ERCP治疗超高龄胆总管结石患者是安全、有效的，可作为治疗超高龄胆总管结石患者的优选方式。

Abstract:

Objective To explore the effectiveness and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the super-older patients ( ≥ 90 years old) with calculus of common bile duct.Methods This study retrospectively analyzed the data of elderly patients ≥ 65 years old with calculus of common bile duct who received ERCP treatment from January 2011 to December 2023. Among of them, patients ≥ 90 years old were in the super-older group, and patients over 65 years old but under 90 years old were in the non-super-older group. Subsequently, the baseline data of gender, number of stones, stone size, cholecystolithiasis, periampullary diverticulum, and common bile duct intubation of patients in the two groups were matched by the 1:1 propensity score matching method. After successful matching, the surgical success rate, stone removal rate, complication rate, and hospital stay in the two groups were compared.Results 428 older patients with calculus of common bile duct were included in this study, including 45 patients in the super-older group and 383 patients in the non-super-older group. After matching baseline data with a 1:1 propensity score matching, 44 patients were included in both the super-older group and non-super-older group. There was no statistically significant difference in the total underlying disease rate between the two groups [ 81.82% (36/44) vs 65.91% (29/44), P = 0.189 ], but the incidence rate of stroke [ 34.09% (15/44) vs 6.82% (3/44) ] and the ASA grading (grade III or IV) [ 97.73% (43/44) vs 38.64% (17/44) ] in the super-older group were significantly higher than those in the non-super-older group (P < 0.01). There were no statistically significant differences between the two groups in terms of ERCP surgical success rate [ 90.91% (40/44) vs 93.18% (41/44) ], stone removal rate [ 65.91% (29/44) vs 81.82% (36/44) ], complication rate [43.18% (19/44) vs 27.27% (12/44)], and median length of stay ( 15.00 d vs 14.50 d ) (P > 0.05).Conclusion ERCP is safe and effective in the super-older patients with calculus of common bile duct .