老年人急性胆囊炎136例诊治体会

目的:探讨老年人急性胆囊炎的临床特点和诊治经验。方法:对手术治疗的136例>60岁老年人急性胆囊炎的临床表现及治疗资料进行回顾性分析,其中急诊手术41例,择期手术95例,其中胆囊切除术120例,胆囊切除并胆总管T性管引流术10例,胆囊大部切除术2例,胆囊造口术4例。结果:痊愈135例,死亡1例。术后并发症以肺部感染、尿路感染、水电解质紊乱、肾功能不全、切口感染为常见,共18例(13%),术后胆道损伤2例。术后冠心病,高血压发作8例,糖尿病血糖波动10例。死亡原因多为心肺功能衰竭和中毒性休克。结论:应根据老年人急性胆囊炎特殊的临床特点,及时选择合适的手术时机及手术方式。

Objective：To examine the clinical characteristics and summarize the experi- ence of diagnosis and treatment of acute cholecystitis in elderly patients. Methods： Retrospective analysis that clinical manifes- tations and treatment of 136 case of acute cholecystitis in the elderly over 60 years old by surgery. Emergency surgery 41 case, 95 case of elective surgery, including 120 cases of cholecystectomy, cholecystectomy and common bile duct T- tube drainage in 10 cases, subtotal resection of the gallbladder in 2 case, 4 cases of gallbladder ostomy. Re- sults ： Among the patients, 135 recovered and 1 died. Eighteen patients developed the postoperative complications （ 13% ）, among with, pulmonary infection, urinary tract inf- cections ,water - electrolyte imbalance, renal insufficiency and wound infection were most common. Postoperative bile duct injury oc- curred in 2 cases. Onset of eoronay heart disease, hypertension and seizures took place in 8 cases post operation. Blood glu- cose fluctuated in 10 patients who had dia- betes history. The cause of death was mostly heart and lung failure, and toxic shock. Conclusion：According to the clinical characteristics of elderly patients with acute cholecystitis, appropriate operative timing and suit-able surgical methods should be chose in time.