经内镜胆道内支架放置术在老年急性梗阻性化脓性胆管炎中的应用价值

Application value of endoscopic retrograde biliary drainage for acute obstructive suppurative cholangitis in the elderly

摘要:

目的 评估经内镜胆道内支架放置术（endoscopic retrograde biliary drainage，ERBD）治疗老年急性梗阻性化脓性胆管炎（acute obstructive suppurative cholangitis，AOSC）的安全性和有效性。方法 回顾性分析新疆医科大学第一附属医院2018年1月—2020年1月期间收治的AOSC患者的临床资料。年龄在75岁及以上的患者设为老年组（n=49），75岁以下的患者设为对照组（n=63），比较两组患者一般资料、美国麻醉医师协会（American Society of Anesthesiologists， ASA）分级、基础疾病伴随情况、手术相关情况、术后并发症发生率及死亡率等指标。结果 老年组和对照组患者在年龄［（82.6±5.1）岁比 （64.6±4.5）岁，t=19.98， P<0.001］、白蛋白水平［（29.1±5.9）g/L 比 （34.6±8.8）g/L，t=-3.94，P<0.001］、ASA分级（χ²=8.37，P=0.015）方面差异有统计学意义。老年组伴随更多的基础疾病，尤其在高血压［57.1%（28/49）比34.9%（22/63），χ²=5.51，P=0.019］、冠心病［（55.1%（27/49）比27.0%（17/63），χ²=9.14，P=0.003］、慢性阻塞性肺疾病/哮喘方面［24.5%（12/49） 比6.3%（4/63），χ²=7.41，P=0.006］差异有统计学意义。在手术相关指标方面，老年组与对照组手术时间［（31.4±8.1）min 比 （30.4±8.0）min，t=-0.61，P=0.543］、住院时间［（6.1±1.7）d 比（5.7±1.4） d，t=1.35， P=0.182］差异无统计学意义。老年组和对照组并发症发生率分别为14.3％（7/49）和12.7％（8/63），差异无统计学意义（χ²=0.06，P=0.807）。在院期间，两组均无手术相关死亡病例。结论 对于75岁及以上的老年AOSC患者，急诊ERBD可迅速缓解病情，是一种安全有效的治疗措施，高龄不是急诊ERBD的绝对禁忌证。

Abstract:

Objective To evaluate the safety and efficacy of endoscopic retrograde biliary drainage (ERBD) for acute obstructive suppurative cholangitis (AOSC) in the elderly. Methods A retrospective analysis was performed on the clinical data of AOSC patients admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2018 to January 2020. Patients aged 75 years and over (n=49) were assigned to the elderly group and patients under 75 years old were assigned to the control group (n=63). General data, American Society of Anesthesiologists (ASA) grading, procedure-related indicators, incidence of postoperative complications and mortality were compared. Results There were significant differences in age (82.6±5.1 years VS 64.6±4.5 years, t=19.98, P<0.001), albumin levels (29.1±5.9 g/L VS 34.6±8.8 g/L, t=-3.94, P<0.001) and ASA grade (χ²=8.37, P=0.015) in the elderly group and the control group . The elderly group were accompanied by more basic diseases, i.e. hypertension [57.14% (28/49) VS 34.9% (22/63), χ²=5.51, P=0.019], coronary heart disease [55.1% (27/49) VS 27.0% (17/63), χ²=9.14, P=0.003], chronic obstructive pulmonary diseases/asthma [24.5% (12/49) VS 6.3% (4/63), χ²=7.41, P=0.006]. There were no significant differences in the operation time (31.4±8.1 min VS 30.4±8.0 min,t=-0.61, P=0.543) or hospital stay (6.1±1.7 days VS 5.7±1.4 days, t=1.35, P=0.182). The incidences of postoperative complications were 14.3% (7/49) in the elderly group and 12.7% (8/63) in the control group, showing no significant difference (χ²=0.06, P=0.807). No ERBD‑related death was observed in either group during hospital stay. Conclusion For elderly patients with AOSC over 75 years old, emergency ERBD, which can quickly relieve the disease, is safe and effective. Advanced age is not an absolute contraindication for emergency ERBD.