多次胆道术后老年重症胆管炎的手术时机与方法

THE METHOD AND TIMING OPERATION FOR ACUTE OF SEVERE TYPE CHOLANGITIS IN ELDERLY PATIENTS WHO UNDERWENT REPEATED BILIARY OPERATIONS

目的 探讨多次胆道术后老年重症胆管为患者手术时机和方法。方法 回顾性分析 4 6例 6 0 y以上多次胆道术后老年重症胆管炎患者临床资料。结果 4 6例全部行手术治疗 ,择期手术 4 4例 (95 .6 5 % ) ,急诊手术 2例 (4 .35 % ) ,术前伴随一种并存病 93.4 7% (三种以上并存病 1 9.5 6 % ) ;术后并发症 39.0 2 % ,死亡率 6 .81 % ,2例 ACST术前死于中毒性休克及MODF,术后死亡 3例 ,2例死于 MODF,1例死于心肺骤停。结论 掌握手术时机和方法 ,不前行 PTCD或 EBEBND,处理并存病 ,争取择期手术 ,避免急诊手术盲目性是外科治疗多次胆道术后老年重症胆管炎 ,减少并发症 。

Objective To study the method and timing of operation in eldely patients who underwent repeated biliary operations with acute cholangitis of severe type.Methods Clinical materials of 46 patients over 60 years old with acute cholangitis of severe type who underwent repeated biliary operations were analyzed retrospectively.Result 46 patients were operated including 44 cases subjected to elective surgery(95.65%) and 2 cases (4.35%) to emergency surgery.The patients had preoperatively concomitant one kind of disease in 93.47% and three kinds of diseases in 19.56%.Postoperative complication occurred in 39.02% patients and mortality in 6.81%( 2 cases of ACST died of toxic shock and MODF before operation, 3 cases died in postoperation;2 cases of MODF ,1 case of cardiopulmonary arrest).Conclusion The important factors to decrease the postoperative complincation and mortality in treatment of acute cholangitis of severe type in elderly patients who underwent repeated biliary operations are to master the operative method and timing,to treat concomitant diseases, to strive for elective surgery(2 weeks～3 months after PTCD or EBEBND),and to avoid unreasonable operation.