老年急腹症外科治疗97例

Surgical treatment of acute abdomen in geriatric patients: an analysis of 97 cases

目的:探讨老年急腹症的外科治疗策略.方法:对2006-2011年收治的97例老年急腹症患者的年龄分布、并存病种类、急腹症原因和手术方法、预后等进行回顾性分析.结果:全组年龄60-98岁(平均69岁±8岁):60-69岁63例,70-79岁23例,80岁以上11例.从发病到就诊所用时间2-240h(69h±61h).引起急腹症的原因包括急性阑尾炎/伴穿孔26例(27%),肠梗阻25例(26%),空腔脏器穿孔18例(18%),嵌顿疝15例(16%),肠道肿瘤11例(11%),原发性腹膜炎2例(2%).并存1种疾病者21例(22%),2种36例(37%),3种32例(33%),4种以上8例(8%).经过以外科手术为中心、多学科联合围手术期处理,行阑尾切除术22例(23%),腹腔引流术8例(8%),肠粘连松解术16例(16%),肠造瘘术13例(13%),肠部分切除11例(11%),穿孔修补术18例(18%),腹股沟疝还纳、疝修补术15例(16%),术后痊愈且没有并发症41例(42%).共52例(54%)发生1种或数种并发症,其中并发肺部感染38例(39%),应激性溃疡4例(4%),泌尿系统感染6例(6%),肾功能异常2例(2%),心功能不全3例(3%),切口感染7例(7%),切口裂开4例(4%),维尼克脑病1例(1%),均经及时治疗后痊愈出院.死亡2例(2%),放弃治疗2例(2%).结论:采取快速和创伤最小的麻醉手术治疗,配合多学科协作治疗老年急腹症可以取得满意的临床效果.

AIM： To discuss the surgical treatment strategies for acute abdomen in geriatric patients. METHODS： A retrospective analysis of the clinical data for 97 patients aged 60 years and above who had undergone emergency surgical interventions from 2006 to 2011 in our department was performed in terms of age, comorbidity, causes of acute abdomen, methods of surgery and outcome. RESULTS： The patients ranged in age from 60 to 98 years （mean, 69 years ± 8 years）, including 63 between 60-69 years, 23 between 70-79 years, and 11 above 80 years. The time between onset of symptoms and diagnosis or surgical treatment is 2-240 h （mean, 69 h ± 61 h）. Causes of acute abdomen include acute appendicitis （27%）, bowel obstruction （26%）, hollow viscus perforation （18%）, strangulated hernia （16%）, colonic neoplasm （11%）, and primary peritonitis （2%）. Of all patients, 22% had 1, 37% had 2, 33% had 3, and 8% have 4 or more comorbidities. Surgeries performed include appendectomy （23%）, abdominal drainage （8%）, ankylenteron lysis （16%）, enterostomy （13%）, bowel resection （11%）, perforation repair （18%）, and hernia repair （16%）. About 42% of patients recovered without complications; 54% experienced one or several complications, including pneumonia, stress ulcer, urinary system infection, renal disfunction; 2% died; and 2% refused further treatment. CONCLUSION： Although acute abdomen is severe and sometimes has worse results in geriatric patients, satisfactory results could be achieved through careful preparation, simple and rapid anesthesia and surgeries, and perioperational treatment.