老年性急性胆囊炎伴胆总管结石患者早期、中期及晚期手术效果及预后分析

Analysis of early,middle and late surgical outcome and prognosis of elderly patients with acute cholecystitis and choledocholithiasis

目的分析早期、中期、晚期手术治疗老年性急性胆囊炎伴胆总管结石的疗效及预后。方法回顾性分析我院2008年1月-2014年1月于我院接受手术治疗的120例老年急性胆囊炎伴胆总管结石患者的临床资料,所有患者均接受腹腔镜胆囊切除术联合胆总管切开取石T管引流术。按手术时间将所有患者分为三组,即早期组(发病至手术时间<72h,n=48)、中期组(发病至手术时间72h-7d,n=40)与晚期组(发病至手术时间>7d,n=32)。比较各组手术情况,统计各组并发症发生率,各组均完成术后12个月随访调查,记录复发率,比较各组生活质量的改善情况。结果①早期组手术时间、住院时间短于中、晚期组(P<0.05),中期组手术时间、住院时间短于晚期组(P<0.05);②术后早期组、晚期组单纯性胆囊炎所占比例高于中期组(P<0.05),早期组化脓性胆囊炎比例多于中期组(P<0.05),早期组、晚期组坏疽性胆囊炎均低于中期组(P<0.05);③早期组切口感染、感染性休克、肺内感染发生率均略低于中期组与晚期组,但对比差异无统计学意义(P>0.05),晚期组肺内感染发生率略高于中期组,中期组胆瘘发生率略高于晚期组、早期组,但对比差异均无统计学意义(P>0.05);④治疗3、6、12个月,各组生活质量评分均上升,早期组上升幅度高于中期组、晚期组,中期组评分上升幅度又高于晚期组(P<O.05);⑤早期组复发率略低于中期组、晚期组,但对比差异无统计学意义(P>0.05)。结论对老年性急诊胆囊炎伴胆总管结石患者多建议在发病72h内接受早期手术处理,以改善患者术后病理,降低并发症发生率,提高患者生活质量。

Objective To analyze early, middle and late surgical outcome and prognosis of elderly patients with acute chole- cystitis and choledocholithiasis. Methods A retrospective analysis of clinical data was carried out in 120 elderly patients with acute cholecystitis and choledocholithiasis accepted surgical treatment in our hospital from January 2008 to January 2014, all patients under- went laparoscopic cholecystectomy combined with common bile duct exploration with T - tube drainage. All patients were divided into three groups according to operation time, namely early group （ duration from onset to operation 〈 72h, n = 48）, middle group （ duration from onset to operation 72h - 7d, n = 40） and late stage group （ duration from onset to operation 〉 7d, n = 32）. Operation conditions in these groups were compared, complication rates in these groups were counted, these groups were followed up for 12 months after the operation, recuremce rates were counted, improvement of the quality of life in these groups were compared. Results①operation time, hospitalization time of early group were significantly shorter than middle group and late stage group （P 〈 0. 05 ）, operation time, hospitalization time of middle group were significantly shorter than late stage group （ P 〈 0. 05 ） ; ②proportion of simple cholecystitis in early group and late stage group after the operation were significantly higher than middle group （ P 〈0.05）, proportion of purulent cho- lecystitis in early group was significantly more than middle group （P 〈 0. 05 ）, gangrenous cholecystitis in early group and late stage group were significantly lower than middle group （P 〈 0. 05 ） ; ③incidence of infection of incisional wound, infectious shock, intrapul- monary infection in early group were slightly lower than middle group and late stage group （ P 〉 0. 05 ）, incidence of intrapulmonary in- fection in late stage group was slightly higher than middle group, incidence of biliary fistula in middle group was slightly higher than late stage group and early group （P 〉 0. 05 ） ; ④after 3, 6 and 12 months of treatment, quality of life score in these groups were signifi- cantly increased, rising range of early group were significantly higher than middle group and late stage group, rising range of scores in middle group were significantly higher than late stage group （P 〈 0. 05 ） ;⑤recurrence rate of early group was slightly lower than mid- dle group and late stage group （ P 〉 0. 05 ）. Conclusion It is recommended to receive early surgical treatment in 72 hours from attack for elderly patients with acute choleeystitis and choledocholithiasis to improve postoperative pathology of patients, reduce complication rate, improve the quality of life of patients.