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目的：研究ERCP 在高年龄患者中应用的有效性和安全性。方法：回顾性分析2010 年6 月-2011 年7 月在本医院进行ERCP 诊治的患者253 例。按年龄分组，其≤65 岁的患者(低年组)115 例, 65 岁-80 岁的患者（中高年组）79 例，≥80 岁的患者(高年组)59 例。记录患者ASA 分级、实验室指标、ERCP 操作以及并发症、住院天数情况，对结果进行统计分析。结果：253 例患者进行了ERCP 操作，失败8 例。胆总管结石患者178 例,恶性肿瘤患者48 例。ERCP 操作成功率为96.8%(95.6%vs 97.4%vs98.3%)，取石成功率98.3%(97.3%vs 98.2%vs100%)，结石取尽率96.6%(96%vs 96.5%vs 97.8%)，高年组患者ASA 分级比中高年和低年组高，差异有统计学意义。术前实验指标差异无统计学意义。186 例接受了乳头括约肌切开(EST)，(71.3%vs 73.4%vs78.0%), 33 例患者采用了预切开术(16.5%%vs 6.3%vs15.3%)，27 例患者术中出现困难插管(13.0%vs 7.59%vs10.2%),ERCP 诊断胆总管结石70.4% (65.2%vs 72.2%vs78.0%)，以上差异均无统计学意义,恶性肿瘤19.0%，多见于高年组患者(12.2%vs 21.5%vs28.8%)，低年组和高年组差异有统计学意义，十二指肠乳头周围憩室39.9%(28.7%vs 48.1%vs50.8%),低年组分别与中高和高年组差异有统计学意义。三组患者行ERCP 后病情缓解天数分别为1.61±0.83,1.39±0.72,1.49±0.70。各种并发症共43 例(17.0%)，低年组25 例(21.7%),中高年组8 例(10.1%)，高年组10 例(16.9%)，无严重并发症及死亡发生。差异均无统计学意义。结论：1. 高年组患者ASA 分级较高，但 ERCP 操作成功率、并发症发生率及治疗后病情缓解天数与其他组患者无差别，ERCP 在老年患者中的应用是安全而有效的。2. 中高年组及高年组十二指肠乳头周围憩室比低年组多见，但对ERCP 操作成功率和并发症发生率无影响。

英文摘要:

Objective: To investigate the effect and safety of ERCP in Elder, Middle and Younger groups of patients．Methods: 253 patients who received ERCP therapy between June 2010 and July 2011 were studied retrospectively. 115 patients (45.5%) were under 65 years of age (Younger group), of which 79 patients (31.2%) were between 65 years of age and 80 (Middle elder group), 59 (23.3%) were more than 80 years old (Elder group). Data about ASA degree, clinical manifestations and biochemical index, ERCP procedures, diagnosis after ERCP, the status of pre-cut and cut papillotomy, complications and length of hospital stay after the surgery were recorded and compared．Results: 8 patients of 253 cases who were undergone ERCP procedures were failed. 178 patients were diagnosed of choledocholithiasis and 48 had malignant tumors .The rate of operational success was 96.8% (95.6%vs 97.4%vs98.3%). The overall successfull rate of stone extraction was 96.6% (96%vs 96.5%vs 97.8%). Elder group had a higher ASA degree than that in Younger and Middle groups (P<0.05)．Laboratory findings were similar in all of the three groups. Papillotomy were performed in 186 patients (71.3%vs 73.4%vs78.0%). Pre-cut papillotomy were performed in 33 patients (16.5%vs6.3%vs15.3%). 27 patients had difficulty in intubating bile duct (13.0%vs 7.59%vs10.2%). The difference between the three groups was not statistically significant. The diagnosis of ERCP: Choledocholithiasis was 70.4% (65.2%vs72.2%vs78.0%). Malignant tumor was19.0% (15.7%vs 19.0%vs25.4%). Compared with that in the Younger group (28.7%), duodenal peripapilla diveniculum was more frequent in the two Elder groups patients (48.1% vs50.8%) (P<0.05). The days of the three groups after ERCP were 1.61±0.83, 1.39±0.72, 1.49±0.70. Post-procedural complications developed in 43 (17.0%) patients．There were 25 (21.7%) complications in the Younger group. In contrast, 8 (10.1%) of the Middle group and 10 (16.9%) of the Elder group developed a complication. There were no serious complications and deaths. Conclusion: 1. Although the ASA of the old is high, they achieved the same effect with the young people. There were similar operational difficulties, outcomes and complications rate in elder, middle and younger patients. So ERCP was effective and safe in the elderly patients 2. The two Elder groups patients were pesented more duodenal peripapilla diveniculums than that in the Young group.

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