关键词: 老年； 胆总管结石； 内镜逆行胰胆管造影术； 胰腺炎； 脂肪酶； C反应蛋白

Abstract: Objective To explore the influencing factors of postoperative pancreatitis in elderly patients with common bile duct stones undergoing endoscopic retrograde cholangiopancreatography (ERCP).Methods 304 elderly patients with common bile duct stones treated with ERCP in our hospital from February 2021 to June 2023 were selected as the study subjects.They were divided into a group with concurrent pancreatitis (n=22) and a group without concurrent pancreatitis (n=282) based on whether postoperative pancreatitis occurred.And the levels of serum lipase,whole blood PLR,and serum CRP were measured before surgery and 3,6,and 24 hours after surgery,respectively.At the same time,the differences in other relevant clinical data between the two groups of patients were compared.Binary Logistic regression was used to analyze the risk factors of pancreatitis after ERCP.Results The serum lipase levels in the concurrent pancreatitis group at 3, 6, and 24 hours after the operation were (1060.48±131.23) U/L, (1137.45±126.34) U/L, and (1152.87±135.05) U/L, respectively. The levels of PLR in whole blood were 192.24±29.26, 216.45±30.24, and 243.62±38.22 respectively, all of which were higher than those in the group without concurrent pancreatitis during the same period. There was a statistically significant difference between the two groups (P<0.05).The serum CRP level in the group with pancreatitis was significantly higher than that in the group without pancreatitis at 6 and 24 h after operation (P<0.05).Body mass index,Oddi sphincter dysfunction,difficulty in intubation,pancreatic development,ERCP operation time >60 min,multiple entry of the catheter into the pancreatic duct were associated with postoperative pancreatitis after ERCP in elderly patients (P<0.05).Multivariate Logistic regression analysis showed that after adjusting for confounding factors such as gender,age,BMI,course of disease,and number of stones,Serum lipase at 3 h after surgery,whole blood PLR at 3 h after surgery,serum CRP level at 6 h after surgery,difficulty in intubation and pancreatic development were independent risk factors for pancreatitis after ERCP in elderly patients (P<0.05).Conclusion Serum lipase,whole blood PLR levels 3 hours after surgery,and serum CRP levels 6 hours after surgery are independent risk factors for pancreatitis after ERCP in the elderly with common bile duct stones.

Key words: the elderly;choledocholithiasis;endoscopic retrograde cholangiopancreatography;pancreatitis;lipase;C-reactive protein