老年急性梗阻性化脓性胆管炎患者30例的外科治疗

Surgical Treatment of Acute Obstructive Suppurative Cholangitis in 30 Elderly Patients

目的探讨老年急性梗阻性化脓性胆管炎的临床诊治措施和效果。方法对30例老年急性梗阻性化脓性胆管炎患者手术治疗的临床资料进行回顾性分析。结果 30例患者均在综合治疗的基础上实施手术治疗。其中行胆总管切开取石、T管引流术25例,行单纯胆总管切开减压、T管引流术5例。梗阻原因:胆总管中下段结石25例,胆总管下段炎性狭窄3例,胆总管下段癌2例。27例患者治愈出院,3例死亡(多器官功能衰竭2例,感染性休克1例),治愈率为90.0%。结论早期诊断、纠正休克,在综合治疗的基础上选择合适的手术方式是老年急性梗阻性化脓性胆管炎治疗成功的关键。

Objective To investigate the effects of treatment measures on acute obstructive suppurative cholangitis in elderly patients.Methods Clinical data of 30 elderly patients with acute obstructive suppurative cholangitis treated with surgery were retrospectively analyzed.Results All patients underwent operation on the base of comprehensive therapy.Among the 30 patients,choledocholithotomy and T-tube drainage were performed in 25,and choledochus incision for decompression and T-tube drainage were performed in 5.The reasons for obstruction included middle and lower choledochus stones in 25 patients,inflammatory stricture of lower choledochus in 3 and lower choledochus cancer in 2.Twenty-seven patients（90.0%）were cured and discharged from hospital.Two patients died of multi-organ failure and 1 patient died of infectious shock.Conclusion Early diagnosis,correcting shock and selecting suitable operation method are the key factors in the treatment of acute obstructive suppurative cholangitis in elderly patients.