老年急性重症胆管炎诊治分析

The diagnostic and therapeutic analysis of elderly patients with acute cholangitis of severe type

目的探讨老年急性重症胆管炎(ACST)的诊治经验和效果。方法对49例老年ACST的诊断和治疗情况进行回顾性分析,并总结老年ACST的诊断要点及分析非手术治疗、手术治疗的效果。结果首诊确诊老年急性重症胆管炎47例,误诊为急性胰腺炎2例。非手术治疗7例,治愈3例,转DCS治疗3例,放弃DCS治疗1例,最终死于多器官功能衰竭。43例老年ACST患者(包括非手术治疗中转DCS3例)采用损伤控制性外科(DCS)技术治疗,9例病人痊愈;34例接受确定性手术,治愈33例,死亡1例。结论老年患者基础病较多,耐受力差,病情较隐匿且发展快,临床医师应加强对老年ACST的认识,减少误诊。早期诊断、选择适宜方式的DCS和再次确定性手术治疗是提高救治成功率的关键。

Objective To explore the diagnosis and treatment of experience and effect in patients with senile acute cholangitis of severe type（ACST）.Methods 49 cases of senile ACST with the diagnosis and treatment were retrospectively analyzed,and summarizes the diagnosis of senile ACST points and analysis of non-surgical treatment,the effect of surgical treatment.Results The first patient diagnosed with ACST 47 cases,misdiagnosed as acute pancreatitis in 2 cases.Non-surgical treatment in 7 cases,cured in 3 cases,turn DCS treatment of three cases;to give up one case of DCS treatment,and eventually died of multiple organ failure.43 cases of senile ACST（including non-surgical treatment of transit DCS 3 cases） were damage control surgery（DCS） in treatment,9 patients recovered;34 patients received definitive surgery again,33 cases were cured,1 died.Conclusion Elderly patients with underlying diseases are more poor tolerance,disease and more rapid development occult,clinicians should strengthen awareness of the elderly ACST,reduce misdiagnosis.Early diagnosis,appropriate choice of the DCS and re-deterministic way of surgery is to improve the treatment success rate of the key.