浙江省ERCP人群特点及疾病趋势的初步研究

A preliminary study on the characteristics of ERCP population and disease trends in Zhejiang Province

摘要:

目的 探讨接受ERCP诊治患者的人群特点及疾病变化趋势。方法 纳入2004年5月至2018年2月在杭州市第一人民医院行ERCP诊治的20 170例患者资料。按诊治年份分为2004—2008年，2009—2013年，2014—2018年3组；按ERCP术后诊断分为胆道疾病（结石、良性狭窄、恶性狭窄、其他病变）和胰腺疾病（急性胰腺炎、慢性胰腺炎、胰腺恶性肿瘤、其他病变）；按年龄分为低龄组（0~18岁）、中青年组（19～65岁）、老年组（66~85岁）、高龄组（>85岁），分别进行分层统计分析。结果 20 170例患者中男10 260例、女9 910例，年龄（62.65±17.11）岁。3个年份组低龄（0~18岁）和高龄（>85岁）患者比例分别为1.04%（24/2 308）、1.69%（127/7 520）、2.39%（247/10 342），和2.95%（68/2 308）、4.19%（315/7 520）、6.15%（636/10 342），总体呈上升趋势（P<0.017）。有明确ERCP术后诊断的患者20 032例，其中胆道疾病15 618例（77.97%），胰腺疾病4 414例（22.03%）。胆道疾病中以胆道结石为主（63.2%，9 863/15 618），比例从2004—2008年的59.9%（1 191/1 987）增长到2014—2018年的64.5%（5 118/7 939）（P=0.000）；胰腺疾病中以急性胰腺炎为主（67.4%，1 973/4 414），比例从2004—2008年的52.4%（162/309）增加到2014—2018年的69.9%（1 636/2 340）（P=0.000）。低龄组疾病前3位为急性胰腺炎（32.58%，129/396）、胆道结石（25.25%，100/396）和慢性胰腺炎（22.22%，88/396），高龄组疾病前3位为胆道结石（56.46%，568/1 006）、胆道恶性狭窄（12.52%，126/1 006）和胆道良性狭窄（10.34%，104/1 006）。结论 接受ERCP诊治的患者以胆道结石为主，急性胰腺炎比例增加；患者总体年龄偏高，高龄及未成年患者比例逐渐增多；高龄患者以胆道疾病为主，低龄患者以胰腺疾病为主。

Abstract:

Objective To investigate the characteristics of population and the changes of disease spectrum in patients treated by endoscopic retrograde cholangiopancreatography (ERCP). Methods Data of 20 170 patients, who underwent ERCP in the First People′s Hospital of Hangzhou from May 2004 to February 2018, were enrolled in the retrospective analysis. According to the year of diagnosis and treatment, patients were divided into 2004-2008, 2009-2013, and 2014-2018 group; according to the postoperative diagnosis of ERCP, they were divided into biliary tract diseases (including calculus, benign stenosis, malignant stenosis, and other causes) and pancreatic diseases (including acute pancreatitis, chronic pancreatitis, pancreatic malignant tumor, and other causes) group; and according to the age, they were divided into the younger age (0-18 years old), young and middle age (19-65 years old), old age (66-85 years old), and advanced age (>85 years old) group. Statistical analysis was performed in the different groups. Results Among the 20 170 patients, there were 10 260 males and 9 910 females, with age of 62.65±17.11 years. The proportion of the younger age group and the advanced age group was 1.04% (24/2 308), 1.69% (127/7 520), 2.39% (247/10 342), and 2.95% (68/2 308), 4.19% (315/7 520), 6.15% (636/10 342), respectively, in the 2004-2008, 2009-2013 and 2014-2018 subgroups, with a rising trend (P<0.017). A total 20 032 patients had a clear postoperative diagnosis, including 15 618 (77.97%) of biliary diseases and 4 414 (22.03%) of pancreatic diseases. Biliary stones accounted for the majority of biliary diseases (63.2%, 9 863/15 618), and its proportion increased from 59.9% (1 191/1 987) in 2004-2008 to 64.5% (5 118/7 939) in 2014-2018 (P=0.000). Acute pancreatitis accounted for the majority of pancreatic diseases (67.4%, 1 973/4 414), and its proportion increased from 52.4% (162/309) in 2004-2008 to 69.9% (1 636/2 340) in 2014-2018 (P=0.000). The top 3 diseases in the younger group and the advanced age group were acute pancreatitis (32.58%, 129/396), biliary stones (25.25%, 100/396), chronic pancreatitis (22.22%, 88/396), and biliary stones (56.46%, 568/1 006), malignant biliary stenosis (12.52%, 126/1 006), benign biliary stricture (10.34%, 104/1 006), respectively. Conclusion The main disease of patients receiving ERCP is biliary stone, and the proportion of acute pancreatitis is increased. The overall age of the patients is old, and the proportion of the elderly and underaged patients is gradually increasing. Biliary diseases and pancreatic diseases are the main diseases in elderly patients and younger patients, respectively.