急诊腹腔镜治疗老年人重症胆管炎38例临床分析

Clinical analysis of laparoscopic therapy of acute severe cholangitis in 38 aged patients

目的:探讨老年急性重症胆管炎(acute severe cholangitis,ASCT)急诊腹腔镜治疗的可行性。方法:回顾本院收治的38例老年ASCT的临床资料,对其临床表现、治疗及预后进行分析探讨。结果:38例内镜及腹腔镜治疗均获成功。无严重并发症,围手术期死亡2例,死亡率5.26%。手术时间为60-189min,平均98.5min,住院时间4-12d,平均8.3d,术中出血50-400ml,平均95.8ml。结论:ASCT患者急诊微创腹腔镜手术治疗可行,且手术越早,效果越好。以微创手术为主的综合治疗是降低ASCT病死率的有效措施。延误手术时机、高龄、合并症是死亡的主要原因。

Objective ： To explore the feasibility of laparoscopic therapy of acute severe cholangitis （ASCT） in aged patients. Methods：Retrospectively analyzed the clinical data of 38 aged patients with ASCT treated in our hospital, and discuss their clinical manifestations,treatment and prognosis. Results：All the endoscopic and laparoscopic operations were successfully performed, with no severe complications. Tow patients died during perioperative period, and the mortality rate was 5.26%. The operating time, hospital stay,and intraoperative bleeding were 60-189min（ mean 98.5rain） ,4-12d（ mean 8.3d） ,and 50-400ml （ mean 95. 8ml ）, respectively. Concluslons：The patients with ASCT should be treated by minimally invasive method as soon as possible, and the sooner, the better. The most effective method to reduce the mortality rate of ASCT is the comprehensive treatment, in which the minimal invasive therapy plays the most important role. On the other hand, delayed operation, old age and the complications are the main causes of death in these patients.