老年消化内镜诊疗技术

1、 1 . World Health Organization . World Health Report 2010 . 2 . Howlader N , Noone AM , Krapcho M et al (eds) . Accessed 27 June 2011 . 3 . Hall KE , Gastroenterology 2005 ; 129 : 1305 38 . 4 . Tierney S , Lillemoe KD , Pitt HA . Adv Surg 1995 ; 28 : 271 99 . 厉有名. 2009 - 2010消化内镜学科年度进展报告 10.0% 11.0%

2、 12.0% 13.0% 60+ 占总人口比例占总人口比例 q q q q Anne C. Travis , MD, FACG1 , Daniel Pievsky , MS, RD2 and John R. Saltzman , MD, Am J Gastroenterol 2012; 107:14951501; Clarke GA , Jacobson BC , Hammett RJ et al. Endoscopy 2001 ; 33 : 580 4 Lee TC , Huang SP , Yang JY et al. Hepatogastroenterology2007 ; 54 : 1

3、319 22 . Lockhart SP , Schofi eld PM , Gribble RJ et al. Br Med J (Clin Res Ed) 1985 ; 290 : 283 . 老年组老年组 46例伴循环系统疾病例伴循环系统疾病 （60岁，岁，64例）例） 18例无循环系统疾病例无循环系统疾病 青年组青年组 （30岁，岁，20例）例） 胃镜检查胃镜检查 前后心钠前后心钠 肽（肽（hANPhANP 和脑钠肽和脑钠肽 （hBNPhBNP） 衡量评价衡量评价 心脏负荷心脏负荷 Fontagnier EM,Monegold BC.Colonoscopy in patients ov

4、er 80 years of age.Indication,methods and results.DMW.2000;125:1319-1322 Schroy P, .polyps, adenocarcinomas,and the intestinaltumors.In:Wolfe MM,Cohen S.eds. Therapy of DigestiveDisorders A Companion to leisenger and Fordtrans Gstrointestinal and liver disease.Philadelphia:saunders;2000:645-673 低血压发

5、生率：低血压发生率： 低龄低龄9% vs.9% vs.高龄高龄15%15% 氧饱和度下降：氧饱和度下降： 低龄低龄19% vs.19% vs.高龄高龄27%27% （但存在哌替啶用量大的干扰）（但存在哌替啶用量大的干扰） 无临床不良事件发生无临床不良事件发生 Lukens FJ,Loeb DS,Mcchicao VI,et al.Colonoscopy inoctogenarians:a prospective outpatient study.Am J Gastroenterol.2002;97:1722-1725. 穿孔发生率：穿孔发生率： 8080岁岁 0.119% 0.119% 总人群

6、总人群0.082%0.082% 年龄是穿孔风险的显著预年龄是穿孔风险的显著预 测值测值 每增加每增加1 1岁，风险提高岁，风险提高1%1% Arora G,Mannalithara A,Singh G,et al.Risk of perforation from a colonoscopy in adults :a large population-based study.Gestrointestinal Endoscopy Mar.2009;69:654-664 Burtin P, Bour B, Charlois T, et al. colonic investigations in th

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8、m J Gastroenteol .2002;97:1722-1725 完完 成成 率率99%99%90%90% 肠道准备不佳肠道准备不佳4%4%16%16% Cabi MA, Achem SR, Kolts BE,et al. Complication rates of colonocopy in octogenarians: is age a risk factor. Gasroenterol 1995;108:A7 Chatrenet P, Friocourt P, Ramain JP, et al.Colonoscopy in the elderly: a study of 200 c

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11、 on life expectancy.JAMA.2006;295:2411-2412 US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. Am Intern Med.2008;149:680-682 Anne C. Travis , MD, FACG1 , Daniel Pievsky , MS, RD2 and John R. Saltzman , MD, Am J Gastroenter

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14、科手术外科手术 术程相关死亡率术程相关死亡率3%3%4%4% 并发症发生率并发症发生率11%11%29%29% Smith AC, Dowsett JF, Russell RC. Randomised trial of endoscopic stenting versus surgical bypass in malignant low bile duct obstruction, Lancet.1994;344:1655-1660 Lai EC, Mok FP, Tan ES. Endoscopic bitiary drainage for severe acute cholangitis.

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16、rointestinal endoscopy in an extremely elderly patient cohort. Endoscopy. 2001;33:580-584. Beaugerle L, Ligvory C, Fritsch J, et al. Lithiaase de la vole biliaire principale du sujet age traintec par vole endoscopique. Gastroenterol Clin Biol.1988;12:320-325. Ashton CB, McNabb WR, Wilkinson ML, et a

17、l. Endoscopic retrograde cholangio-pancreatography in elderly patients. Aging.1998;27:683-688. 低龄组低龄组高龄组高龄组 并发症并发症3.45%3.45%1.65%1.65% 胰腺炎胰腺炎1.16%1.16%0.14%0.14% 出血出血0.75%0.75%0.55%0.55% 穿孔穿孔0.41%0.41%0.69%0.69% 死亡死亡0%0%0.1%0.1% Lukens FJ,Howell DA,Upender S,et al.ERCP in the Very Elderly:outcomes a

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