老年人胆道疾病的外科治疗

SURGICAL MANAGEMENT OF BILIARY TRACT DISEASE IN THE AGED

目的 探讨 6 0岁以上老年人胆道疾病的外科处理方法及其效果。方法 回顾性总结了 1992年 1月～ 2 0 0 0年 1月间12 7例老年胆道疾病的外科治疗情况。结果 本组胆囊切除和 /或胆总管探查术 78例 ,胆囊造瘘术 12例 ,各类型胆肠吻合术 2 7例 ,Oddis括约肌切开成形术 3例 ,PTCD4例 ,剖腹探查、组织活检术 3例 ,本组中联合左肝外叶切除 11例。术后总病死率 5 .5 % ,急诊手术病死率 12 .8% ,择期手术的占 2 .3% ,x2 =3.92 37,P<0 .0 5。结论 对老年胆道疾病患者 ,尤其存在合并症者 ,应积极作好围手术期处理 ,在适当的时机选择适合老年病人特点的手术方式 ,以期最大限度地减少术后并发症 ,降低病死率。

Objective To study the method and effect of the surgical thearpy for biliary tract disease in the elderly.Methods Retrospective study of the clinical data from 127 patients aged over 60 years with biliary tract disease who were admitted to our hospital from January 1992 to January 2000.Results Cholecystectomy or choledochostomy were performed in 78 cases,cholecystostomy in 12 cases,choledochojejunostomy in 27 cases,Oddis sphincterotomy in 3 cases.Various underlying diseases were found in 87 cases before operation and most of them were cardiovascular diseases.The operative mortality was 5.5%(12.8% in emergency group,2.3% in elective group).Conclusion It is suggested that reasonable surgical intervention slould be performed for biliary tract disease in the aged with careful perioperative management.