老年急性胆囊穿孔38例临床分析

Clinical Analysis of 38 Elderly Patients with Acute Perforation of Gallbladder

目的探讨老年急性胆囊穿孔的外科治疗方法。方法回顾性分析2008年1月—2012年6月我院收治的38例老年胆囊穿孔的临床资料。结果全组均有不同程度腹痛,部分患者伴发热、腹膜刺激征、黄疸,术前均行B超检查,13例误诊,误诊率34.2%。误诊为胆囊结石并胆囊炎6例,消化性溃疡穿孔3例,急性胰腺炎、急性肠梗阻各2例。38例均经手术治疗证实胆囊穿孔。术后发生并发症16例,其中肺部感染5例,切口感染3例,膈下脓肿2例,多器官功能衰竭、肝脓肿、中毒性休克、心力衰竭、急性肺栓塞及下肢深静脉血栓形成各1例。死亡4例,病死率10.5%。结论老年急性胆囊穿孔临床表现不典型,易误诊,B超检查有助于诊断。一旦确诊,应尽早进行手术。术后并发症与并存疾病关系密切,需高度重视。

Objective To explore the surgical treatment for acute perforation of gallbladder in elderly patients.Methods Clinical data of 38 elderly patients with acute perforation of gallbladder during January 2008 and June 2012 were retrospectively analyzed.Results All patients had different degrees of abdominal pain,and some patients ran a fever with peritoneal irritation sign and jaundice.All patients underwent B-mode ultrasonography examinations before operation,and 13 patients（34.2%） were misdiagnosed.Six patients were misdiagnosed as having cholecystolithiasis combined with cholecystitis,three misdiagnosed as having peptic ulcer perforation,two misdiagnosed as having acute pancreatitis and two misdiagnosed as having acute ileus.The 38 patients were confirmed perforation of gallbladder by surgical treatment.In 16 patients with postoperative complications,there were 5 patients with pulmonary infection,3 patients with incision infection,2 patients with subphrenic abscess,1 patient with multiple organ failure（MOF）,1 patient with liver abscess,1 patient with toxic shock,1 patient with heart failure,1 patient with acute pulmonary embolism and 1 patient with deep venous thrombosis of the lower extremity.Four patients died,and fatality rate was 10.5%.Conclusion The acute perforation of gallbladder in elderly patients is atypical and tends to be misdiagnosed,and B-mode ultrasonography may be helpful in diagnosis.Surgical treatment should be performed as quickly as possible after confirming diagnosis.Postoperative complications have a close relation with combined diseases,which needs more attention.