老年胆道疾病患者的外科治疗

目的 探讨60岁以上老年胆道疾病的外科治疗及效果。方法 回顾性总结1998年1月－2000年12月间452例60岁以上老年胆道疾病患者的手术治疗情况。结果 本组有合并症342例,占75.7%,胆囊切除术249例,胆囊切除及胆总管探查145例,胆肠内引流26例,胆总管内置支架3例。术后发生并发症75例,占16.6%,其中急诊手术组为32.6%,择期手术组为7.08%,总病死率为2.65%。结论 60岁以上老年患者合并症多,应尽可能了解全面病情,适时进行手术治疗,采取合适的手术方式,可提高手术成功率,降低并发症率和病死率。     

老年急性梗阻性胆囊炎36例治疗体会

随着老龄人口的增加,老年人胆道疾病的比例相对增高。本文总结在南开医院外科进修期间观察治疗的胆囊结石手术４３５例,其中６０岁以上的急性梗阻性胆囊炎３６例,现介绍如下。１临床资料１１本组３６例,占同期胆囊手术的８３％。其中男性１１例,女性２５例;６０...     

高龄腰椎管狭窄症的围手术期治疗

我院从１９９０～１９９５年开展下腰椎手术８２７例,其中对７０岁以上的老年人腰椎管狭窄症进行手术２７例,占３３％,效果良好,无意外死亡及严重并发症,现分析总结如下：１临床资料１１一般资料２７例中男１６例,女１１例,年龄最小７０岁,最大８２岁,平均７...     

医源性胆道损伤的手术处理错误与纠正

医源性胆道损伤是胆囊切除的灾难性并发症。为了防止医源性胆道损伤,提高手术的效果,我们回顾性分析了１９９０年３月～１９９８年１２月我科收治医源性胆道损伤７７例。由于种种手术的失误,致使每例平均２．９次手术。本文从分析手术处理错误入手,提出纠正的方法。１　一般资料１９９０年３月～１９９８年１２月,我科收治院内外因结石性胆囊炎施择期胆囊切除致医源性胆道损伤７７例,全组男性２５例,女性５２例,平均年龄４４．６岁（２２岁～６２岁）。其中开腹胆囊切除６９例,电视腹腔镜胆囊切除７例,微切口胆囊切除１例。胆囊切…     

联合肝切除治疗肝内胆管结石并狭窄

目的探讨联合肝切除组合胆道手术治疗肝内胆管结石并狭窄的疗效。方法回顾性总结四年来联合肝切除组合胆道手术治疗肝内胆管结石并狭窄８２例,其中,肝左外叶切除６５例（７９．２７％）,左半肝切除１２例（１４．６３％）,右肝部分切除３例（３．６６％）,左肝外叶＋右前叶下段切除１例（１．２２％）。结果手术后结石取净７８例（９５．１２％）,术后纤维胆道镜取石３例,２例结石取净,总的结石取净率为９８．７８％（８０／８２）,手术并发症７例（８．５３％）,死亡１例（１．２２％）,８１例术后随访１个月～４年,肝内结石复发３例（３．７０％）。结论联合肝切除组合胆道手术是治疗肝内胆管结石并狭窄的有效方法、联合肝切除必须掌握适应证,急症肝切除的并发症多且较严重,术后纤维胆道镜检查与治疗对诊治残余结石有重要意义。     

开腹手术致胆管损伤的预防

医源性胆管损伤多见于胆囊切除、胆管探查及胃、肝手术后。我科收治１４５例损伤性胆管狭窄中，胆囊切除术后５４％，胆管探查术后５４％，胃术后５４％。全国六届胆道会议报告１６９７４例腹腔手术，胆管损伤１０５例，发生率０６２％，以上３种手术类型分别占９...     

高龄原发性肝癌病人的手术治疗

我院自１９８２年２月－１９９４年１１月手术治疗７０岁以上高龄原发性肝癌患者共３０例，其中剖腹探醒２例，肝切除２８例，手术切除率９３．３％。本组无手术死亡，术后并发症发生率为２０％，均经及时处理痊愈出院。     

97例急症胆道手术并发症分析

自１９９４年１月１９９６年６月，我产共对９７例胆道急是病人施行急症手术治疗，治愈９４例（９６．９％），死亡３例（３．１％），７６例病人出现并发症，发生率为７８．３％，本语文就胆道疾病急症手术的有关总是及并发症的处理进行讨论     

70岁以上老年人胆石症外科手术治疗体会

目的 探讨老年人胆石症的临床特点、手术适应证、手术治疗方法及围术期处理。方法 回顾217例70岁以上老年胆石症患者，针对合并症、手术方式、手术时机、治疗效果等进行综合分析。结果本组70岁以上手术患者217例，并发症65例（30．6％），死亡1例（0．5％），疗效满意。结论 掌握手术的适应证和手术时机、处理合并症、争取择期手术及避免急诊手术盲目性是外科治疗老年胆道疾病、减少并发症、降低死亡率的关键。     

胆道良性疾病老年患者的治疗分析

目的探讨老年胆道良性疾病的治疗方式选择。方法回顾性分析了1999年5月-2005年4月218例60岁以上老年人胆道良性疾病的治疗情况，分为手术组和非手术组，分析了疾病种类分布、合并症类型、治疗方式选择和治疗结果。结果75．2％的患者存在不同类型的合并症。206例行手术治疗，其中急诊95例，手术并发症33例。总死亡率2．29％。结论针对老年患者并存病多和术后并发症多的特点，强化围手术期处理是提高手术成功率，降低并发症和病死率的关键。     

老年人胆道疾病的外科治疗

目的　探讨 6 0岁以上老年人胆道疾病的外科处理方法及其效果。方法　回顾性总结了 1992年 1月～ 2 0 0 0年 1月间12 7例老年胆道疾病的外科治疗情况。结果　本组胆囊切除和 /或胆总管探查术 78例 ,胆囊造瘘术 12例 ,各类型胆肠吻合术 2 7例 ,Oddis括约肌切开成形术 3例 ,PTCD4例 ,剖腹探查、组织活检术 3例 ,本组中联合左肝外叶切除 11例。术后总病死率 5 .5 % ,急诊手术病死率 12 .8% ,择期手术的占 2 .3% ,x2 =3.92 37,P<0 .0 5。结论　对老年胆道疾病患者 ,尤其存在合并症者 ,应积极作好围手术期处理 ,在适当的时机选择适合老年病人特点的手术方式 ,以期最大限度地减少术后并发症 ,降低病死率。     

高龄胆道疾病89例外科治疗经验

目的　探讨高龄 (70岁以上 )胆道疾病的外科治疗方法。方法　回顾性分析了我院 13年来手术治疗 70岁以上高龄胆道疾病 89例的经验。急诊手术 4 7例 (5 2 .8% ) ,择期手术 4 2例 (47.2 % )。结果　治愈 80例 (89.9% ) ,死亡 5例 (5 .6 % ) ,未愈出院 4例 (4.5 % )。术后发生并发症 35例 (39.3% )。结论　择期手术应进行全面细致的体检 ,积极治疗合并病 ,选择好合适的手术时机。急诊应边抢救边检查 ,术中进行监测 ,手术应简单实用有效。术后全面监测生命体征变化 ,发现问题及时处理 ,预防并发症发生     

Cholecystitis in the octogenarian: is laparoscopic cholecystectomy the best approach?

Management of biliary disease in the octogenarian has evolved over the last decade. Laparoscopic cholecystectomy is now more commonly performed in this patient population. Octogenarians with biliary pathology frequently present with complications of acute disease such as biliary pancreatitis, choledocholithiasis, and acute cholecystitis. As a result, laparoscopic management in this patient population can frequently be more challenging than in younger patients. We retrospectively reviewed 70 patients who were 80 years of age and older who underwent cholecystectomy at our institution for biliary tract disease. Seventeen patients presented to the Day Surgery unit for elective management of chronic biliary disease. Sixteen (94%) of these patients were attempted laparoscopically and one (6%) underwent open cholecystectomy. Two patients attempted laparoscopically were converted to open surgery (conversion rate 12.5%). Average length of hospital stay was 3.7 days for those treated laparoscopically and 11 days for patients treated with open cholecystectomy. There were three complications (19%) in this group and no deaths. The remaining 53 patients presented via the emergency room with acute complications of cholelithiasis. Laparoscopic cholecystectomy was attempted in 28 (52%) and open cholecystectomy was performed in 25 (48%) patients. Ten (37%) of the patients attempted laparoscopically were converted to an open procedure. Average length of stay in this group was 11.7 days for those treated laparoscopically and 15.7 days for patients managed with open technique. There were ten (56%) complications in the laparoscopic group and five (14%) complications in the open group. There were four deaths (22%) among those treated laparoscopically and three deaths (8.6%) in the open cholecystectomy group. Comorbid conditions were common in the patients with acute biliary pathology and those presenting for elective cholecystectomy. Laparoscopic cholecystectomy is the procedure of choice in the elective management of biliary tract disease in the octogenarian. Laparoscopic cholecystectomy has no benefit with respect to morbidity and mortality over open cholecystectomy in the management of acute biliary tract disease in this elderly population. When possible, chronic cholecystitis in the elderly should be managed with elective laparoscopic cholecystectomy rather than waiting for complications to develop.     

Clinical problems in the surgical treatment of pancreaticobiliary maljunction

The results of surgical treatment of pancreaticobiliary maljunction at our department are described. The 67 patients who underwent surgery for this disease were divided by age into an adult group (45 patients, aged 16 years and over) and a pediatric group (22 patients, aged less than 16 years). The incidence of concomitant carcinoma before surgery and the incidence and severity of postoperative cholangitis were compared between these two groups. In addition, the cell proliferating activity of the biliary tract epithelium in cancer-free patients was compared between the two groups, using the proliferating cell nuclear antigen labeling index (PCNA LI). Ten patients (all adults) were diagnosed with cancer (gallbladder carcinoma in 7 and bile duct carcinoma in 3) before surgery. The surgical techniques used for reconstruction in the cancer-free patients were: in the adult group, hepaticoduodenostomy in 9 patients, Roux-en-Y hepaticojejunostomy in 17, jejunal interposition in 8, and another technique in 1. In the pediatric group, hepatico-duodenostomy was performed in 17 patients. Roux-en-Y hepaticojejunostomy in 3, and jejunal interposition in 2. Postoperative cholangitis occurred in 6 adults (including 2 with severe form) and 1 child (mild case). The PCNA LI of the biliary tract epithelium was high compared to control findings in the biliary tract epithelium of 10 adult patients without pancreaticobiliary maljunction. In the adult group with dilated extrahepatic bile ducts (n=10 examined) this index was 11.4% for the bile duct epithelium (control, 1.5%) and 12.7% for the gallbladder epithelium (control, 1.4%). In the adult group with non-dilated extrahepatic bile ducts (n=5 examined) it was 5.9% for the bile duct epithelium and 13.1% for the gallbladder epithelium. In the pediatric group (n=10 with extrahepatic bile duct dilatation) it was 7.5% for the bile duct and 9.7% for the gallbladder epithelium. (Differences from control values were all significant.) These results suggest that surgery for this disease should be performed as early as possible and that extrahepatic bile duct excision and biliary reconstruction should be performed whether or not extrahepatic bile ducts are dilated.     

Acute pancreatitis in the aged

Forty-seven patients aged more than 75 years with acute pancreatitis were studied. The most common cause of acute pancreatitis was biliary tract stones. The clinical presentation and severity of the disease as judged by the number of poor prognostic factors were not different from the group of patients aged less than 75 years. The mortality rate in the older group was thrice that of the younger group (21.3% versus 7.24%). The higher mortality rate was explained by a higher incidence of deaths related to complications of biliary stones and coincidental diseases. Significantly more aged patients with mild disease died, indicating the limitation of predictive ability of the scoring system in acute pancreatitis of the aged.     

70岁以上心脏病患者手术治疗体会

目的 总结70岁以上心脏病患者的手术治疗体会。方法 自1995年5月至2000年7月进行70岁以上高龄患者心脏手术23例,单纯冠状动脉搭桥术13例,单纯瓣膜手术5例,瓣膜手术同时冠状动脉搭桥术3例,心包剥脱同期冠状动脉桥术1例,左房粘液瘤摘除术1例。结果 术后出现并发症5例（21．7％）,死亡1例（4．3％）,无围手术期心肌梗塞、高血压危象和酮症酸中毒等。存活22例随访1个月－5年,心功能和生活质量明显改善。结论 高龄心脏病应及时就诊,一旦有手术适应证应及早外科治疗,临床效果满意,积极的围术期管理是手术成功的关键。     

Acute disorders of the biliary tract in geriatric patients]

Acute pathologies of the biliary tract in geriatric patients were examined in this study taking into account the major causes, treatment used and results obtained. All patients aged over 65 who had been hospitalised during the past 17 years for acute pathologies of the biliary tract (564 cases, equivalent to 34.2% of all in-patients suffering from acute biliary pathologies) were included in the study. These patients were then subdivided into 3rd and 4th age groups (65-74 and < 75 years respectively). The results obtained in the 3rd age group (267 patients, 60%) showed the greatest number of cases of inflammatory lithiasic disease of the cholecystus (61.2%) and VBP (17.7%), whereas 45 patients, equivalent to 49.5%, presented tumours with jaundice. Out of a total of 179 cases in patients in the 4th age group, equivalent to 39.3%, 119 (66.5%) were suffering from lithiasic cholecystitis and 16 (8.9%) from calcolosis of the VBP with jaundice. Cancer of the pancreas head was diagnosed in 27 patients (58.7%), whereas 9 (19.6%) had obstruent cancer of the biliary tract. The Authors conclude that both the preoperative preparation, the choice of operation and postoperative treatment give satisfactory results with a very low early mortality (0.8% in non-tumour cases and 6.9% in tumour cases).     

Choledochoscopy in common bile duct surgery for choledocholithiasis: A must: Eight years experience in 441 consecutive patients

Between 1975 and 1983, 441 choledochoscopy were performed in a series of 451 consecutive patients undergoing surgical common biliary duct exploration for choledocholithiasis. In 127 patients (27.8%), no stones were found. Forty-five cases (10%) of choledocholithiasis missed by surgical and radiologic exploration methods were found by choledochoscopy. Therefore the retained stone rate decreased from 10 per cent to 2 per cent. Fourteen patients (3%) died at surgery, ten of whom (2%) were over 70. Postoperative biliary tract was drained in 98 patients (8%) using external drainage. Biliary tract patency was checked on the tenth postoperative day by the tube cholangiography. When retained stones were not found, T-tube was removed on the 20th day after surgery. When retained stones were found (11 patients, 2%) an endoscopic papillotomy was performed. Choledochoscopy is a significant addition in biliary surgery. It reduces operative mortality and morbidity, decreases retained stone rate, diminishes indications for biliary anastomosis and sphincterotomy, and is easy to perform without specific training. Its extensive and systematic use is advocated when- ever common bile duct patency has to be surgically demonstrated in choledocholithiasis.