老年人急性重症胆管炎手术时机和死亡原因的探讨

ANALYSIS OF DEATH CAUSES AND SELECTION OF OPERATIONAL TIMING FOR OLDER PATIENTS WITH ACUTE CHOLANGITIS OF SEVERE TYPE(ACST)

目的探讨老年人急性重症胆管炎(ACST)的手术时机与死亡原因。方法对我院2000年6月～2008年12月手术治疗的老年人急性重症胆管炎70例患者手术时机、术式及病死率进行回顾性研究。结果(1)手术病死率为12.86%,性别及病因分类无差异。(2)24小时内手术与24小时后手术的死亡率分别为8.33%和17.65%,二者差异具有显著意义。(3)手术死亡率与器官衰竭个数的增多明显增加。(4)手术方式与手术死亡率无关。结论老年人急性重症胆管炎的早期判断,手术的充分扩容治疗及手术时机与手术方式的掌握,是减少并发症和降低死亡率的关键。

Objective To evaluate timing of operation cause of death of older patients acute cholangitis of severe type （ACST）. Method The timing, mode of operation and mortality were reviewed retrospectively in 70 older ACST cases under going laparotomy in our hospital from June 2000 to December 2008. Restult （ 1 ） The over all operative mortality was 12. 86%. with no difference in etiology and sex. （2）in 24 h operative mortality was 8.33% ,the 24 h later operative mortality was 17. 65%. the difference between 24 h operation and later operation was significant statistically. （3）The operative mortality increased when the number of injured organs increasd. （4）operative mode have not to do with operative mortality. Conclusion Early diagnosed, and well management before operation and selecting the operative timing are the key to reducing complications and mortality rate.