手术治疗老年急腹症患者110例分析

Surgery for acute abdomen in the elderly

目的探讨笔者所在医院手术治疗老年急腹症患者的临床资料,进一步提高老年急腹症患者手术疗效。方法选择2009年5月～2010年10月笔者所在医院手术治疗老年急腹症患者110例。其中男58例,女52例,年龄65～93岁,平均(74.0±5.5)岁,其中86例(78.2%)合并至少一种基础疾病。结果手术证实急性阑尾炎43例,占39.1%;机械性肠梗阻38例,占34.5%;空腔脏器穿孔16例,占14.5%;胆结石并急性胆囊或胆管炎11例,占10.0%;绞窄性疝2例,占1.8%。其中96例(87.3%)术后顺利康复无主要并发症;14例(12.7%)术后合并至少一种并发症(包括死亡),主要为心肺并发症13例、感染性休克1例。术后3例住院死亡,死亡原因分别为围术期心肌梗死2例、感染性休克1例。结论老年患者急腹症总体疗效满意,临床工作中应全面分析,及早诊断,积极审慎手术处理。

Objective To review our experience and results in the surgical treatment of the acute abdomen in elderly patients.Methods From March 2009 to October 2010,110 consecutive patients（58males,52females）aged 65 to 93 years,mean age（74.0±5.5） were operated for acute abdomen.A total of 86 patients（78.2%）had one or more associated disease.Results The causes for emergency operation were acute appendicitis（43cases,39.1%）,mechanical bowel obstruction（38cases,34.5%）,hollow viscus perforation （16,14.5%）,cholelithiasis with cholecystitis or cholangitis（11cases,10.0%）and strangulated hernia（2cases,1.8%）.96 patients （87.3%）recovered and were free from major complications.The remaining 14（12.7%）developed at least one major complication （including death）.The commonest complications were cardio-respiratory in 13（11.8%）patients,septic complications in 1（0.9%）.The in hospital death were 3（2.7%）and the causes of death were acute myocardial infarction in 2 and in Septic shock 1 patients.Conclusion The overall success of surgical interventions for abdominal emergency is satisfactory in the majority of older people.