Clinical Characteristics Analysis Of 164 AOSC Patients Undergoing Emergency ERCP

Objective:Analyze the clinical manifestations,bacterial distribution,laboratory examination,and treatment characteristics of emergency endoscopic retrograde cholangiopancreatography（ERCP）in patients with acute obstructive suppurative cholangitis（AOSC）.At the same time,by comparing the efficacy and complications of emergency ERCP between elderly patients and non elderly patients,we explore the impact of age factors on it,and provide certain assistance for future clinical diagnosis and treatment of AOSC patients.Methods:Using a retrospective analysis method,AOSC patients who visited Lanzhou University Second Hospital from January 1,2020 to January 1,2022 were included.Clinical data of the patients were collected,and SPSS26.0 software was used to statistically analyze the clinical characteristics,bacterial distribution,empirical antibiotic use,ERCP surgical efficacy,and postoperative complications of AOSC patients.Then,at the age of 65,the patients were divided into a non elderly group and an elderly group,and the differences in baseline data,preoperative laboratory indicators,intraoperative diagnosis,postoperative efficacy,and postoperative complications between the two groups were compared.The normality test is carried out for all measurement data,and the data conforming to the normal distribution are subject to two independent sample t-test and paired sample t-test.The results are expressed as mean±standard deviation,that is（x±s）;The Mann-Whitney U test is used for data that do not conform to the normal distribution,and the results are represented by the median（interquartile spacing）,namely M(P₂₅,P₇₅).The counting data is represented by examples（%）,and comparison is made using chi-square test,Corrects the chi-square test,Fisher’s exact test.Results:1.A total of 164 AOSC patients were included in this study,including 92 males（56.1%）and 72 females（43.9%）;The average age is 66.6 years,ranging from 20 to 86 years old;The ethnic group is mainly Han（89.6%）;Clinical manifestations included abdominal pain in 153 patients（93.3%）,jaundice in 116 patients（70.7%）,fever in 83 patients（50.6%）,consciousness disorders in 21 patients（12.8%）,and shock in 4 patients（2.4%）;The disease history mainly included 62 cases（37.8%）of biliary and pancreatic diseases,45 cases（27.4%）of diabetes and 20 cases（12.2%）of hypertension.A total of 121 cases of bile culture were performed,including 104 cases of Gram negative bacteria（86.0%）,16 cases of Gram positive bacteria（13.2%）,and 1 case of fungi（0.8%）.150 patients experienced the use of antibiotics,including 116 cases treated with antibiotics alone and 34 cases treated with antibiotics in combination.Among them,antibiotics used alone were mainly third-generation cephalosporinsβ-The combination of ceftriaxone sodium and ornidazole is the main combination of antibiotics in lactam enzyme inhibitor compound preparation.After emergency ERCP surgery,the levels of RBC,TBIL,WBC,NE,HGB,DBIL,IBIL,ALT,AST,GGT,and ALP in AOSC patients significantly decreased compared to before surgery（P<0.001）,while LY significantly increased compared to before surgery（P<0.001）.There were 20 postoperative complications after emergency ERCP,including 13 cases of pancreatitis（7.9%）,5 cases of delayed bleeding（3.0%）,1 case of cardiac tear（0.6%）,and 1 case of nasobiliary duct prolapse（0.6%）.2.164 patients with AOSC were divided into non elderly group（<65 years old）（64 cases）and elderly group（≥65 years old）（100 cases）.The two groups were comparable in general data such as fever,abdominal pain,jaundice,disturbance of consciousness,shock,history of diabetes,history of biliary surgery,heart rate,preoperative temperature,postoperative temperature,length of hospital stay and hospital costs（P>0.05）.This study found that the incidence of malignant biliary obstruction in the elderly group was higher than that in the non elderly group（P<0.05）,and the use rate of plastic biliary stents and the rate of basket stone removal in the elderly group were lower than those in the non elderly group（P<0.05）.There were statistical differences between the two groups in hypertension history,respiratory rate,preoperative RBC,preoperative ALT,preoperative AST,postoperative NE,postoperative LY,postoperative RBC,postoperative HGB,and postoperative ALT（P<0.05）.There was no statistically significant difference in the postoperative efficacy and incidence of complications between the two groups of patients undergoing emergency ERCP（P>0.05）.Conclusion:1.The main cause of AOSC patients in our hospital is bile duct stones.Escherichia coli is the most common bacteria in bile culture,and the empirical use of antibiotics is usually third-generation cephalosporins combined with nitroimidazoles.2.There is no significant difference in the efficacy and incidence of complications after emergency ERCP between the elderly group and the non elderly group.Emergency ERCP treatment is also effective and safe for elderly people aged 65 and above.