老年病人内镜逆行胰胆管造影术术后并发症以及危险因素分析  

Analysis of postoperative complications of endoscopic retrograde cholangiopancreatography in older patients and risk factors

作　　者：董杨帆[1] 哈力木拉提·吾布力卡斯木 刘郁[1] 马裕盛 江莱 段绍斌[1,2] Dong Yangfan;Wubulikasimu Halimulati;Liu Yu;Ma Yusheng;Jiang Lai;Duan Shaobin(First Department of General Surgery,Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine,the Fourth Affiliated Hospital of Xinjiang Medical University,Institute of Traditional Chinese Medicine,Xinjiang Urumqi 830011,China;The Fourth Clinical Medical College of Xinjiang Medical University,Xinjiang Urumqi 830011,China)

机构地区：[1]新疆维吾尔自治区中医医院,新疆医科大学第四附属医院,新疆维吾尔自治区中医药研究院普外一科,新疆乌鲁木齐830011 [2]新疆医科大学第四临床医学院,新疆乌鲁木齐830011

出　　处：《腹部外科》2025年第2期123-127,共5页Journal of Abdominal Surgery

摘　　要：目的探讨老年病人内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)术后并发症发生情况,并分析其危险因素。方法回顾性收集2017年10月至2023年12月期间在新疆医科大学第四附属医院住院行ERCP检查或治疗成功的老年病人400例,其中男性228例,女性172例。根据病人是否发生术后并发症分为两组:并发症组和对照组。记录两组病人一般情况、术前诊断、合并症、实验室检查等情况。采用单因素回归分析术后发生严重并发症的危险因素。结果一共32例病人术后发生并发症,术后并发症发生率为8.0%。与对照组相比,并发症组病人年龄更大(P=0.003),体重指数偏低(P=0.013),高血压和糖尿病控制不良、肺功能障碍、既往ERCP病史、插管困难、Oddi括约肌功能障碍、胆总管狭窄病人更多(均P<0.05)。单因素回归分析显示,年龄(OR=1.25,95%CI:1.05~1.22,P=0.001)、体重指数(OR=0.88,95%CI:0.78~0.98,P=0.02)、血压控制不良(OR=2.0,95%CI:1.5~4.0,P=0.0001)、血糖控制不良(OR=1.5,95%CI:1.00~2.01,P=0.02)、肺功能障碍(OR=0.88,95%CI:0.78~0.98,P=0.02)、既往ERCP病史(OR=2.2,95%CI:1.45~3.01,P=0.001)、Oddi括约肌功能障碍(OR=3.82,95%CI:2.15~5.88,P=0.001)、胆总管狭窄(OR=1.48,95%CI:0.49~4.51,P=0.002)与老年病人ERCP术后并发症有关。结论老年病人的年龄、体重指数、高血压和糖尿病控制不良、肺功能障碍、既往ERCP病史、Oddi括约肌功能障碍及胆总管狭窄均与ERCP术后并发症显著相关。老年病人ERCP术后并发症发生率较低,且无严重并发症,ERCP诊疗是安全有效的。Objective To investigate the postoperative complications of endoscopic retrograde cholangiopancreatography(ERCP)in older patients and risk factors.Methods A total of 400 patients who underwent ERCP or those who were successfully treated in the Fourth Affiliated Hospital of Xinjiang Medical University from October 2017 to December 2023 were retrospectively involved,including 228 males and 172 females.Patients were divided into two groups according to whether they had postoperative complications:control group and complication group.The general conditions,preoperative diagnosis,comorbidities,laboratory examinations of the two groups were recorded.Univariate regression analysis was used to analyze the risk factors for serious complications after surgery.Results A total of 32 patients had postoperative complications,and the incidence of postoperative complications was 8.0%.Compared with the control group,the patients in the complication group were significantly older(P=0.003),and had significantly lower body mass index(BMI)(P=0.013),higher proportions of poorly controlled hypertension and diabetes mellitus,pulmonary dysfunction,history of ERCP,difficult intubation,Sphincter of Oddi dysfunction(SOD),proportion of common bile duct stenosis(P<0.05).Univariate regression analysis showed that age(OR=1.25,95%CI:1.05-1.22,P=0.001),BMI(OR=0.88,95%CI:0.78-0.98,P=0.02),poorly controlled blood pressure(OR=2.0,95%CI:1.5-4.0,P=0.0001),poorly controlled blood glucose(OR=1.5,95%CI:1.00-2.01,P=0.02),pulmonary dysfunction(OR=0.88,95%CI:0.78-0.98,P=0.02),history of ERCP(OR=2.2,95%CI:1.45-3.01,P=0.001),SOD(OR=3.82,95%CI:2.15-5.88,P=0.001),and common bile duct stenosis(OR=1.48,95%CI:0.49-4.51,P=0.002)were associated with postoperative complications of ERCP.Conclusion In older patients,factors such as age,BMI,poorly controlled hypertension and diabetes,pulmonary dysfunction,prior ERCP history,sphincter of Oddi dysfunction,and CBD stenosis are all significantly associated with post-ERCP complications.The incidence of postoperative complica

关 键 词：内镜逆行胰胆管造影术 术后并发症 老年病人 危险因素 

分 类 号：R616.2[医药卫生—外科学]