老年急腹症180例诊治

Think highly of the treatment of senile patients with acute abdomen

目的探讨老年人急腹症的临床特点和手术治疗效果。方法对四川省科学城医院1995-07/2005-07收治的180例老年人急腹症患者中126例实施手术治疗者的诊断、治疗进行回顾性分析。结果180例老年人急腹症患者中,男88例,女92例,平均年龄72岁,最大80岁。急性阑尾炎60例,占33.3%;急性胆囊炎、胆石症48例,占26.5%;肠梗阻29例,占16.1%;溃疡病穿孔、出血21例,占11.7%;急性化脓性胆管炎4例,占2.2%;急性胰腺炎4例,占2.2%;腹部闭合伤8例;脾破裂3例;肠破裂2例;肝损伤1例。合并有高血压74例,占40.1%;冠状动脉粥样硬化性心脏病18例,占10%;糖尿病15例,占8.3%;慢性支气管炎17例,占9.1%;脑血管意外4例,占2.2%;其他52例。并存2种以上疾病的36例,占20%;心电图有异常发现的82例,占40.6%;有126例手术126例,其中痊愈89例,占70.6%,好转31例,占24.6%,术后出现并发症26例,占20.6%,其中肺部感染11例,占42.3%;,死亡6例,占4.1%,误诊26例,占11.1%。结论老年急腹症患者病情复杂多变,缺乏典型症状和体征,容易误诊,合并症多,明确术前诊断,与内科协作处理合并症,选择合适的手术方法和麻醉方式,掌握好手术时机,从而减少老年急腹症患者的病死率和并发症。

Objective Explore the clinical feathers and effects of the operation on senile patients with acute abdomen.Methods 180 senile patients with acute abdomen in our hospital were analyzed.Their average age was 72-year-old.Among them 126 cases were treated with various operations.80% of them have various concomitant diseases include hypertension,diabetes,chronic bronchitis and cerebrovascular disease.45 of them were accompanied by more than one kind of those diseases.Results Among 126 cases with operations,89 cases were recovery,31 cases were improvement.26 cases of them suffered from postoperative complications,they included pneumonia(11 cases).6 cases were dead,26 cases were misdiagnosed.Conclusion The confirmed diagnosis with acute abdomen in senile patients was difficulty for their condition changed rapidly and their clinical manifestations were not typical.The treatment was also difficult for they often have more than one kind of diseases and less resistance to diseases.But the incidence of the postoperative complications and mortality can decrease with confirmed preoperative diagnosis for senile patients,proper treatment of their concomitant diseases with the help of physicians and well-timed for suitable operation and anaesthesia.