老年人胆囊炎102例围手术期处理体会

Experience in the cholecystectomy for 102 elderly patients

目的探讨65岁以上老年人胆囊切除的围手术期的处理体会。方法回顾性分析我院普外科2000年1月～2004年9月共102例老年人在胆囊切除围手术期治疗的临床资料。结果102例手术治疗中,有11例慢性萎缩性胆囊炎、7例急性坏疽性胆囊炎,因calot三角显露困难,强行切除胆囊有易误伤胆管、大出血的危险,采用完全破坏胆囊黏膜功能,术后疗效与切除相同;合并胆囊内瘘3例,占2.94%;合并心肺疾病22例,占21.57%,合并糖尿病13例,占12.75%,1例死亡。结论术中彻底破坏胆囊黏膜功能,疗效与切除相同,且增加老年人手术的安全性。加之内科合并症多见,应严格围手术期监护与处理,以确保安全。

Objective To discuss the experience in the treatment in peri-operative period of cholecyst resection for the people over 65 years old. Methods The clinic data of 102 elderly patients treated in the peri-operative period of cholecyst resection between January 2000 and September 2004 were reviewed. Results One hundred and two cases were performed successfully, chronic atrophous occurred in 11 cases and acute gangrenous cholecystiffs in 7 eases. Because there was difficulty dissecting the Calot triangle and forced cholecyst resection would run the risk of bile duty injury and stress hemorrhage, the approach of complete damage of cholecyst mueosa function was adopted, obtaining the same post-operative result as the cholecyst resection. Of 102 cases, 3 cases were compli-eated with cholecyst fistula （2.94%）, 22 cases with heart and lung diseases （21.57%）, 13 cases with diabetes （12.75%） and one died. Conclusions In the operation, completely damaging cholecyst mucosa function has the same post-operative result as cholecyst resection, evidently increasing the operative safety for elderly patients. With medical complications frequently oceurrlng, careful observation and nursing of the patients are strictly required to ensure that elderly patients go through the peri-operative period safe and steady.