老年人胆源性急性胰腺炎的早期外科治疗体会

目的总结老年人胆源性急性胰腺炎早期外科治疗的经验。方法对1997年1月至2007年1月10年间,收治的39例老年人胆源性急性胰腺炎患者早期外科治疗的临床资料进行回顾性分析。结果39例老年人胆源性急性胰腺炎,术中均见胆总管有不同程度的扩张,其中33例胆总管内有大小不等的结石,12例有脓性胆汁。36例治愈出院。手术后死亡率为7.69%（3/39）,死亡原因为呼吸功能衰竭或多器官功能衰竭5例发生手术后胆漏,发生率为12.8%（5/39）。结论早期积极的胆道取石和/或胆道置管引流、减压等处理,是成功治疗老年人胆源性急性胰腺炎的有效手段。但由于老年人多有重要器官功能不全等,手术风险大,术后并发症多,应遵循“个体化方案”的治疗原则,重视维持水电解质酸碱平衡和血液循环的稳定,加强围手术期处理。

Early surgical treatment of acute biliary pancreatitis in elderly

Objective To study experience of early surgical treatment for the elderly with acute biliary pancreatitis.Methods From Jan 1997 to Jan 2007 39 elderly patients with acute biliary pancreatitis were analyzed retrospectively.Results Different degree dilation of common bile duct(CBD)was observed in 39 cases.Among them,33 were found with stones in CBD,12 with purulence-like bile.The total cure rate was 92.3%(36/39),incidence of bile leakage was 12.8%(5/39)after operation.The mortality rate was 7.69%(3/39),and the cause of death was respiratory function failure or multiple organ dysfunction symdrone.Conclusion Early cholecystectomy,and/or choledochostomy were effective method in treatment for the elderly with acute biliary pancreatitis.Respecting the elderly patient's condition,careful perioperative treatment and individualized therapeutic strategy were necessary.