ERCP在老年患者梗阻性黃疸診斷中的應用價值△_《中國普外基礎與臨床雜志》

作者：

 徐旭東 ¹ , 吳亞群 ¹ , 劉志蘇 ² , 孫權 ² , 張林 ¹

1.華中科技大學同濟醫學院附屬同濟醫院普外科（湖北武漢430030）;;
2. 武漢大學中南醫院普外科（湖北武漢430071）;

關鍵詞：

內鏡逆行性胰膽管造影老年患者梗阻性黃疸診斷應用價值

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目的探討內鏡逆行性胰膽管造影（ERCP）對老年患者梗阻性黃疸的診斷價值。方法根據年齡將338例梗阻性黃疸患者分為老年組（年齡≥60歲）和非老年組（年齡 lt;60歲），檢測2組患者常規ERCP后6、24和48 h 血淀粉酶（AMY）和肝功能的變化，對2組患者造影成功率、診斷準確率及并發癥發生率進行分析。結果2組患者ERCP后血AMY、轉氨酶（ALT）及總膽紅素（TBIL）的差異無統計學意義（P gt;0.05）。非老年組患者ERCP造影成功率為96.3%(130/135)，老年組患者ERCP造影成功率為96.1%(195/203)，2組之間差異無統計學意義（P gt;0.05）。老年組患者ERCP診斷準確率（98.5%,192/195）明顯高于非老年組(84.6%,110/130),差異有統計學意義（P lt;0.05）。非老年組患者ERCP后并發癥發生率為14.8%（20/135），老年組患者并發癥發生率為17.2%（35/203），2組間差異無統計學意義（P gt;0.05）。2組患者ERCP后均無死亡病例。結論ERCP對老年患者梗阻性黃疸是一種安全、有效、準確的診斷方法，具有重要的臨床意義。

引用本文： 徐旭東,吳亞群,劉志蘇,孫權,張林. ERCP在老年患者梗阻性黃疸診斷中的應用價值△. 中國普外基礎與臨床雜志, 2011, 18(1): 55-58. doi: 復制

1.	Hancock SM, Spier BJ, Pfau PR. Hemorrhagic emphysematous cholecystitis presenting as obstructive jaundice and hemobilia [J]. Gastrointest Endosc, 2008， 68(1): 151152.
2.	Papachristou GI, Smyrk TC, Baron TH. Endoscopic retrograde cholangiopancreatography tissue sampling: when and how? [J]. Clin Gastroenterol Hepatol, 2007， 5(7): 783790.
3.	Burdiukov MS, Nechipaǐ AM, Iurichev IN. Assessment of severity of obstructive jaundice of tumoral genesis for predicting of endoscopic retrograde cholangiopancreatography and endoscopic retrograde biliary decompression complications [J]. Eksp Klin Gastroenterol, 2010， (4): 7885.
4.	Katsinelos P, Paroutoglou G, Kountouras J, et al. Efficacy and safety of therapeutic ERCP in patients 90 years of age and older [J]. Gastrointest Endosc, 2006， 63(3): 417423.
5.	Laasch HU. Obstructive jaundice after bilioenteric anastomosis: transhepatic and direct percutaneous enteral stent insertion for afferent loop occlusion [J]. Gut Liver, 2010， 4(Suppl.1): S89S95.
6.	Nakakura EK, Warren RS. Palliative care for patients with advanced pancreatic and biliary cancers [J]. Surg Oncol, 2007， 16(4): 293297.
7.	辛波，張林波，姜喜遠，等. 惡性梗阻性黃疸介入治療與手術引流比較 [J]. 中國普外基礎與臨床雜志, 2010， 17(3): 233236.
8.	Loew BJ, Howell DA, Raju R, et al. ERCP tissue sampling of cholangiocarcinoma presenting with biliary obstruction permits intraprocedural diagnosis and results in high positive yield [J]. Gastrointest Endosc, 2008， 67(5): AB229AB230.
9.	劉雙, 劉軍, 孫文生, 等. 硝酸甘油預防ERCP術后胰腺炎及高淀粉酶血癥的臨床應用研究 [J]. 中國普外基礎與臨床雜志, 2009， 16(8): 641644.
10.	Sasaki T, Kato D, Matsuoka N, et al. Limy bile syndrome complicated by obstructive jaundice [J]. Int Surg, 2010， 95(1): 4953.
11.	Matsubayashi H, Kakushima N, Onozawa Y, et al. Endoscopic biliary drainage using guidewire cannulation in a case with severe duodenal stenosis caused by duodenal undifferentiated carcinoma [J]. Case Rep Gastroenterol, 2010， 4(1): 2530.
12.	Saad AM, Fogel EL, McHenry L, et al. Pancreatic duct stent placement prevents postERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction but normal manometry results [J]. Gastrointest Endosc, 2008， 67(2): 255261.
13.	李汛, 朱曉亮, 周文策, 等. 經內鏡胰管支架置入在預防ERCP術后胰腺炎高危患者中的臨床應用 [J]. 中國普外基礎與臨床雜志, 2010， 17(10): 10061009.
14.	Horiuchi A, Nakayama Y, Kajiyama M, et al. Effect of precut sphincterotomy on biliary cannulation based on the characteristics of the major duodenal papilla [J]. Clin Gastroenterol Hepatol, 2007， 5(9): 11131118.
15.	Ozdil B, Cosar A, Kece C, et al. The diagnostic value of endoscopic balloon catheter usage for detecting earlystage primary sclerosing cholangitis in endoscopic retrograde cholangiopancreatography: a case report [J]. Case Rep Gastroenterol, 2010， 4(1): 15.
16.	Nuwayhid NS, Ballard ET, Cotton R. Esophageal papillomatosis: case report [J]. Ann Otol Rhinol Laryngol, 1977， 86(5 Pt 1): 623625.
17.	Keil R, Snajdauf J, Rygl M, et al. Diagnostic efficacy of ERCP in cholestatic infants and neonates-a retrospective study on a large series [J]. Endoscopy, 2010， 42(2): 121126.
18.	Papamichail M, Nikolaidis N, Anastasiou E, et al. Massive subcutaneus emphysema following endoscopic retrograde cholangiopancreatography with sphincterotomy [J]. Case Rep Gastroenterol, 2010， 4(3): 399403.
19.	GüitrónCantú A, AdalidMartínez R, GutiérrezBermúdez J, et al. Endoscopic retrograde cholagiopancreatography in the elderly: A prospective and comparative study in Northern Mexico [J]. Rev Gastroenterol Mex, 2010， 75(3): 267272.
20.	Vitale GC, Tran TC, Davis BR, et al. Endoscopic management of postcholecystectomy bile duct strictures [J]. J Am Coll Surg, 2008， 206(5): 918923.
21.	李汛, 朱曉亮, 沈亦萱, 等. 鎮靜、鎮痛麻醉在治療性ERCP中的安全性評估及應用 [J]. 中國普外基礎與臨床雜志, 2009， 16(8): 645648.
22.	Lundstrm P, Sandblom G, Osterberg J, et al. Effectiveness of prophylactic antibiotics in a populationbased cohort of patients undergoing planned cholecystectomy [J]. J Gastrointest Surg, 2010， 14(2): 329334.
23.	Dumonceau JM, Andriulli A, Deviere J, et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline: prophylaxis of postERCP pancreatitis [J]. Endoscopy, 2010， 42(6): 503515.
24.	李海洋, 孫誠誼, 潘耀振, 等. 不同途徑膽道支架置入治療惡性梗阻性黃疸42例回顧分析 [J]. 中國普外基礎與臨床雜, 2009， 16(4): 300303.
25.	金安琴, 黃曉俊, 王偉, 等. 早期內鏡治療急性膽源性胰腺炎46例臨床研究 [J]. 中國普外基礎與臨床雜志, 2010， 17(10): 10011005.
26.	Bisceglia M, Simeone A, Forlano R, et al. Fatal systemic venous air embolism during endoscopic retrograde cholangiopancreatography [J]. Adv Anat Pathol, 2009， 16(4): 255262.

1. Hancock SM, Spier BJ, Pfau PR. Hemorrhagic emphysematous cholecystitis presenting as obstructive jaundice and hemobilia [J]. Gastrointest Endosc, 2008， 68(1): 151152.
2. Papachristou GI, Smyrk TC, Baron TH. Endoscopic retrograde cholangiopancreatography tissue sampling: when and how? [J]. Clin Gastroenterol Hepatol, 2007， 5(7): 783790.
3. Burdiukov MS, Nechipaǐ AM, Iurichev IN. Assessment of severity of obstructive jaundice of tumoral genesis for predicting of endoscopic retrograde cholangiopancreatography and endoscopic retrograde biliary decompression complications [J]. Eksp Klin Gastroenterol, 2010， (4): 7885.
4. Katsinelos P, Paroutoglou G, Kountouras J, et al. Efficacy and safety of therapeutic ERCP in patients 90 years of age and older [J]. Gastrointest Endosc, 2006， 63(3): 417423.
5. Laasch HU. Obstructive jaundice after bilioenteric anastomosis: transhepatic and direct percutaneous enteral stent insertion for afferent loop occlusion [J]. Gut Liver, 2010， 4(Suppl.1): S89S95.
6. Nakakura EK, Warren RS. Palliative care for patients with advanced pancreatic and biliary cancers [J]. Surg Oncol, 2007， 16(4): 293297.
7. 辛波，張林波，姜喜遠，等. 惡性梗阻性黃疸介入治療與手術引流比較 [J]. 中國普外基礎與臨床雜志, 2010， 17(3): 233236.
8. Loew BJ, Howell DA, Raju R, et al. ERCP tissue sampling of cholangiocarcinoma presenting with biliary obstruction permits intraprocedural diagnosis and results in high positive yield [J]. Gastrointest Endosc, 2008， 67(5): AB229AB230.
9. 劉雙, 劉軍, 孫文生, 等. 硝酸甘油預防ERCP術后胰腺炎及高淀粉酶血癥的臨床應用研究 [J]. 中國普外基礎與臨床雜志, 2009， 16(8): 641644.
10. Sasaki T, Kato D, Matsuoka N, et al. Limy bile syndrome complicated by obstructive jaundice [J]. Int Surg, 2010， 95(1): 4953.
11. Matsubayashi H, Kakushima N, Onozawa Y, et al. Endoscopic biliary drainage using guidewire cannulation in a case with severe duodenal stenosis caused by duodenal undifferentiated carcinoma [J]. Case Rep Gastroenterol, 2010， 4(1): 2530.
12. Saad AM, Fogel EL, McHenry L, et al. Pancreatic duct stent placement prevents postERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction but normal manometry results [J]. Gastrointest Endosc, 2008， 67(2): 255261.
13. 李汛, 朱曉亮, 周文策, 等. 經內鏡胰管支架置入在預防ERCP術后胰腺炎高危患者中的臨床應用 [J]. 中國普外基礎與臨床雜志, 2010， 17(10): 10061009.
14. Horiuchi A, Nakayama Y, Kajiyama M, et al. Effect of precut sphincterotomy on biliary cannulation based on the characteristics of the major duodenal papilla [J]. Clin Gastroenterol Hepatol, 2007， 5(9): 11131118.
15. Ozdil B, Cosar A, Kece C, et al. The diagnostic value of endoscopic balloon catheter usage for detecting earlystage primary sclerosing cholangitis in endoscopic retrograde cholangiopancreatography: a case report [J]. Case Rep Gastroenterol, 2010， 4(1): 15.
16. Nuwayhid NS, Ballard ET, Cotton R. Esophageal papillomatosis: case report [J]. Ann Otol Rhinol Laryngol, 1977， 86(5 Pt 1): 623625.
17. Keil R, Snajdauf J, Rygl M, et al. Diagnostic efficacy of ERCP in cholestatic infants and neonates-a retrospective study on a large series [J]. Endoscopy, 2010， 42(2): 121126.
18. Papamichail M, Nikolaidis N, Anastasiou E, et al. Massive subcutaneus emphysema following endoscopic retrograde cholangiopancreatography with sphincterotomy [J]. Case Rep Gastroenterol, 2010， 4(3): 399403.
19. GüitrónCantú A, AdalidMartínez R, GutiérrezBermúdez J, et al. Endoscopic retrograde cholagiopancreatography in the elderly: A prospective and comparative study in Northern Mexico [J]. Rev Gastroenterol Mex, 2010， 75(3): 267272.
20. Vitale GC, Tran TC, Davis BR, et al. Endoscopic management of postcholecystectomy bile duct strictures [J]. J Am Coll Surg, 2008， 206(5): 918923.
21. 李汛, 朱曉亮, 沈亦萱, 等. 鎮靜、鎮痛麻醉在治療性ERCP中的安全性評估及應用 [J]. 中國普外基礎與臨床雜志, 2009， 16(8): 645648.
22. Lundstrm P, Sandblom G, Osterberg J, et al. Effectiveness of prophylactic antibiotics in a populationbased cohort of patients undergoing planned cholecystectomy [J]. J Gastrointest Surg, 2010， 14(2): 329334.
23. Dumonceau JM, Andriulli A, Deviere J, et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline: prophylaxis of postERCP pancreatitis [J]. Endoscopy, 2010， 42(6): 503515.
24. 李海洋, 孫誠誼, 潘耀振, 等. 不同途徑膽道支架置入治療惡性梗阻性黃疸42例回顧分析 [J]. 中國普外基礎與臨床雜, 2009， 16(4): 300303.
25. 金安琴, 黃曉俊, 王偉, 等. 早期內鏡治療急性膽源性胰腺炎46例臨床研究 [J]. 中國普外基礎與臨床雜志, 2010， 17(10): 10011005.
26. Bisceglia M, Simeone A, Forlano R, et al. Fatal systemic venous air embolism during endoscopic retrograde cholangiopancreatography [J]. Adv Anat Pathol, 2009， 16(4): 255262.

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ERCP在老年患者梗阻性黃疸診斷中的應用價值△

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《中國普外基礎與臨床雜志》

ERCP在老年患者梗阻性黃疸診斷中的應用價值△

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