老年人急性胆囊炎120例临床分析

目的:探讨老年人急性胆囊炎的临床特征、手术方式以及并发症的预防和处理。方法:回顾分析手术治疗120例60岁以上老年人急性胆囊炎患者的临床资料。结石性胆囊炎82例。并发弥漫性腹膜炎8例。黄疸35例。中毒性休克3例。病情危重者98例,占82%。结果:均行剖腹探查,术中见胆囊坏疽51例,其中胆囊穿孔8例;行胆囊切除98例,胆囊部分切除取石12例,胆囊造瘘10例。完全康复者108例(占90%),术后并发黄疸35例。切口感染裂开1例。肾功能衰竭1例,多脏器功能衰竭5例,6例均死亡。结论:老年急性胆囊炎不同于一般年轻患者,结石是致病的主要原因,发病急骤、病情危重、手术病死率高;B超可使绝大多数患者确诊,强调术前尽可能对合并症进行控制、做好充分准备、尽早积极剖腹探查,手术采取从简、彻底冲洗、充分引流的原则。

Clinical analysis of acute cholecystitis in senile patients-a report of 120 cases

Objective:To investigate the diagnosis,surgical procedures,prevention and treatment of complications in aged patients with acute cholecystitis.Methods:A retrospective study was made in the findings of 120 over 60-year old patients with acute cholecystitis from January in 1997 to January in 2007.Results:There were 22 males and 98 females,aged from 60 to 82 years in the study.Almost 83% of them were concomitant with chronic diseases including hypertension,COPD,diabetes,coronary heart disease,and 68% of the cholecystitis cases were due to cholelithiasis determined by B-mode ultrasonography.Diffuse peritonitis presented in 8 cases,jaundice in 35,toxic shock in 3,and 83% of all the patients underwent a critically ill state.All patients received a laparotomy,resulting in 34 cases with gangrenous cholecystitis,8 cases with cholecyst perforation.Cholecystectom was performed in 98 cases,partial cholecystectomy and cholelithotomy in 12,and cholecystostomy in 10.Postoperatively,there were 35 cases complicated with jaundice,1case with incision infection,1case with renal failure,5 with multiple system organ failure,and 6 incurring death.The others recovered uneventfully.Conclusions:Apparently different from younger patients,the clinical features of acute cholecystitis in the senile are characteristic of hurried onset and critical state of the illness,multiple complications and high mortality.Moreover,Cholelithiasis is the most inducement of acute cholecystitis in old people.B-mode ultrasonography is useful to make a correct diagnosis for most of the patients.An aggressive pre-operative preparations including effective control of comorbidities,earlier surgical intervention,and simpler but more efficacious surgical procedures such as thorough irrigation and effective drainage are a guarantee for successful operation and reduction of postoperative complications and mortality.