高龄病人胆道手术的围手术期处理

目的: 探讨高龄病人胆道手术的围手术期处理方法.方法: 回顾分析我院1999年至2002年间82例各类高龄胆道病人(年龄74~96岁)的术前准备及术后处理方法.其中,伴有各类心脏疾病35例,糖尿病5例,高血压21例,肺通气功能障碍物13例,电解质紊乱3例,肾功能不全4例,肝功能损害31例.结果: 全组均行手术治疗(包括择期或急诊手术).其中,1例胆囊癌行根治术,1例胆总管囊肿行囊肿切除、胆管空肠Roux-Y吻合术,1例胆总管下端狭窄行EST术,其余各例分别行胆囊切除、胆总管探查、T管引流术,有5例同时加做空肠造瘘术并行早期EN治疗.81例治愈出院,1例死于心肺功能衰竭.结论: 良好的围手术期处理是高龄胆道病人手术成功的关键.

Perioperative management of biliary tract surgery for elderly patients

Objective:To discuss the method of perioperative management of biliary tract surgery for elderly patients.Methods:Clinical data of 82 cases(age from 74 to 96) of biliary tract underwent various surgical procedures in our hospital from 1999 to 2002 were analyzed retrospectively. Thirty-five cases were accompanied with different kinds of heart diseases,5 cases were accompanied with diabetes. Twenty-one cases had hypertension,13 cases were accompanied with ventilatory disorder. Three cases with electrolyte disorder. Four cases with renal malfunction. Thirty-one cases with liver malfunction.Results:All of the patients were undergone surgery. One case was undergone radical operation for carcinoma of gallbladder,one case cystectomy and Roux-y cholangio-jejunostomy for choledochocyst,one case EST for stenosis of biliary tract. The others were undergone cholecystectomy,common bile duct exploration and T tube drainage. Five of them were undergone jejunostomy at same time and early EN. Eighty-one cases recovered and discharged. One case died of cardiac-pulmonary failure.Conclusion:The appropriate perioperative management is critical to the success of biliary tract surgery for elderly patients.