• 1.華中科技大學(xué)同濟(jì)醫(yī)學(xué)院附屬同濟(jì)醫(yī)院普外科（湖北武漢430030）;;
  • 2. 武漢大學(xué)中南醫(yī)院普外科（湖北武漢430071）;

目的探討內(nèi)鏡逆行性胰膽管造影（ERCP）對(duì)老年患者梗阻性黃疸的診斷價(jià)值。方法根據(jù)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(cè)2組患者常規(guī)ERCP后6、24和48 h 血淀粉酶（AMY）和肝功能的變化，對(duì)2組患者造影成功率、診斷準(zhǔn)確率及并發(fā)癥發(fā)生率進(jìn)行分析。結(jié)果2組患者ERCP后血AMY、轉(zhuǎn)氨酶（ALT）及總膽紅素（TBIL）的差異無統(tǒng)計(jì)學(xué)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(tǒng)計(jì)學(xué)意義（P gt;0.05）。 老年組患者ERCP診斷準(zhǔn)確率（98.5%,192/195）明顯高于非老年組(84.6%,110/130),差異有統(tǒng)計(jì)學(xué)意義（P lt;0.05）。非老年組患者ERCP后并發(fā)癥發(fā)生率為14.8%（20/135），老年組患者并發(fā)癥發(fā)生率為17.2%（35/203），2組間差異無統(tǒng)計(jì)學(xué)意義（P gt;0.05）。2組患者ERCP后均無死亡病例。結(jié)論ERCP對(duì)老年患者梗阻性黃疸是一種安全、有效、準(zhǔn)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(quán),張林. ERCP在老年患者梗阻性黃疸診斷中的應(yīng)用價(jià)值△. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(1): 55-58. doi: 復(fù)制

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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(yuǎn)， 等. 惡性梗阻性黃疸介入治療與手術(shù)引流比較 [J]. 中國普外基礎(chǔ)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(yù)防ERCP術(shù)后胰腺炎及高淀粉酶血癥的臨床應(yīng)用研究 [J]. 中國普外基礎(chǔ)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(jīng)內(nèi)鏡胰管支架置入在預(yù)防ERCP術(shù)后胰腺炎高危患者中的臨床應(yīng)用 [J]. 中國普外基礎(chǔ)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(zhèn)靜、鎮(zhèn)痛麻醉在治療性ERCP中的安全性評(píng)估及應(yīng)用 [J]. 中國普外基礎(chǔ)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(chǔ)與臨床雜, 2009， 16(4): 300303.
25. 金安琴, 黃曉俊, 王偉, 等. 早期內(nèi)鏡治療急性膽源性胰腺炎46例臨床研究 [J]. 中國普外基礎(chǔ)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. 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. 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. 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. 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. 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. 6. Nakakura EK, Warren RS. Palliative care for patients with advanced pancreatic and biliary cancers [J]. Surg Oncol, 2007， 16(4): 293297.
  7. 7. 辛波， 張林波， 姜喜遠(yuǎn)， 等. 惡性梗阻性黃疸介入治療與手術(shù)引流比較 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010， 17(3): 233236.
  8. 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. 9. 劉雙, 劉軍, 孫文生, 等. 硝酸甘油預(yù)防ERCP術(shù)后胰腺炎及高淀粉酶血癥的臨床應(yīng)用研究 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009， 16(8): 641644.
  10. 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. 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. 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. 13. 李汛, 朱曉亮, 周文策, 等. 經(jīng)內(nèi)鏡胰管支架置入在預(yù)防ERCP術(shù)后胰腺炎高?；颊咧械呐R床應(yīng)用 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010， 17(10): 10061009.
  14. 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. 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. 16. Nuwayhid NS, Ballard ET, Cotton R. Esophageal papillomatosis: case report [J]. Ann Otol Rhinol Laryngol, 1977， 86(5 Pt 1): 623625.
  17. 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. 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. 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. 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. 21. 李汛, 朱曉亮, 沈亦萱, 等. 鎮(zhèn)靜、鎮(zhèn)痛麻醉在治療性ERCP中的安全性評(píng)估及應(yīng)用 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009， 16(8): 645648.
  22. 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. 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. 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(chǔ)與臨床雜, 2009， 16(4): 300303.
  25. 25. 金安琴, 黃曉俊, 王偉, 等. 早期內(nèi)鏡治療急性膽源性胰腺炎46例臨床研究 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010， 17(10): 10011005.
  26. 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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