老年人急性坏疽性胆囊炎的诊断与治疗

目的总结老年人急性坏疽性胆囊炎的诊断与治疗，以减少并发症，降低死亡率。方法对112例老年人急性坏疽性胆囊炎的临床资料进行回顾性分析。结果112例患者中有高热l9例（17．0％），黄疸8例（7．1％），右上腹包块11例（9．8％），腹膜炎体征26例（23．2％）；并发急性水肿型胰腺炎11例（9．8％），急性梗阻性化脓性胆管炎5例（4．5％），感染性休克6例（5．4％）．112例均手术治疗，术中发现95例急性结石性胆囊炎中胆囊坏疽79例，坏疽并穿孔16例，穿孔者占16．8％；17例急性非结石性胆囊炎中胆囊坏疽8例，坏疽并穿孔9例，穿孔者占52．9％。112例中行胆囊切除术86例，胆囊大部切除术l8例，胆囊切除加胆道探查T管引流术5例，胆囊造瘘术3例。治愈104例（92．9％），死亡8例（7．1％），治愈104例中出现术后并发症9例（8．7％）。病理报告均为急性坏疽性胆囊炎。结论老年人急性坏疽性胆囊炎应尽早诊断，合理处理并存病，应争取在起病后24h内（或入院后的最短时间内）内急诊手术，并选择适当的手术方式。

The diagnosis and treatment of acute gangrenous cholecystitis in senile patients

Objective To study the diagnosis and treatment of acute gangrenous cholecystitis in senile (patients), so as to decrease complications and lower the mortality rate. Methods The clinical data of 112 senile patients with acute gangrenous cholecystitis were retrospectived analysed.Results 19 cases(17.0%) of the 112 patients had hyperpyrexia, 8(7.1%) had icterus,11(17.0%) had a mass in the right upper abdomen, 26(23.2%) had symptoms of peritonitis; 11(9.8%) were complicated with acute edematous pancreatitis, 5(4.5%) had acute obstructive suppurative cholangitis, 6(5.4%) had septic shock. All of the 112 patients underwent surgery. At operation, 79 of 95 cases of acute calculous cholecystitis had (gangrene) of gallbladder,16(16.8%) had gangrene with perforation; in 17 cases with acute non-calculous cholecystitis had gangrene of gallbladder, 9(52.9%) had gangrene with perforation. Of the 112 patients, 86 underwent cholecystectomy, 18 underwent partial cholecystectomy, 5 underwent cholecystectomy with bile duct exploration and T tube drainage, and 3 underwent cholecystostomy 104 patients(92.9%) were cured, 8 patients(7.1%) died, and 9(8.7%) of the 104 cured patients had postoperative complications. (Conclusions) Acute gangrenous cholecystitis in senile patients should be definitely diagnosed as soon as (possible), co-existent diseases should be correctly treated, emergency operation should be performed with in 24 hours of onset of symptoms(or in the shortest time after admission), and a suitable operation should be (selected).