老年结石性胆囊炎临床特点及手术体会

Clinical Characteristics and Surgical Experience of Elderly Calculous Cholecystitis

目的探讨老年人结石性胆囊炎的临床特点、手术时机及方式。方法回顾性分析笔者所在医院2008年1月至2014年4月期间收治的386例老年结石性胆囊炎患者的临床资料。结果本组386例患者中慢性结石性胆囊炎234例,急性期结石性胆囊炎152例;术前有合并疾病者174例(45.08%);234例慢性结石性胆囊炎患者均行择期手术,急性期152例中35例在发病72 h内手术,其余117例则在发病2周内手术。行腹腔镜胆囊切除术(LC)283例,其中8例中转开腹手术;行常规开腹胆囊切除术103例。术后出现并发症49例,并发症发生率为12.69%,包括切口感染、肺部感染、急性尿潴留、尿路感染、胆瘘等。治愈384例,死亡2例,为胆囊结石合并重症急性胆管炎,术后3 d因多器官衰竭死亡。结论老年结石性胆囊炎具有独特的临床特点;严格掌握手术指征,合理选择手术时机,采取符合病情的个体化手术方式,强化围手术期处理,是提高老年结石性胆囊炎临床治愈率及手术成功率的关键。

Objective To explore the clinical characteristic, operation time, and methods of elderly calculous cholecystitis. Methosds The data of 386 cases of elderly calculous cholecystitis in our hospital from January 2008 to April 2014 were retrospectivly analyzed. Results In 386 patients, 234 cases were chronic cholecystitis, 152 cases were acute calculous cholecystitis; there were preoperative complications in 174 cases （45.08%）; 234 cases of chronic calculous cholecystitis patients underwent elective operation, 35 cases in 152 cases of acute phase underwent operation at 72 h, the remaining 117 cases underwent operation in within 2 weeks of onset. Laparoscopic cholecystectomy （LC） were in 283 cases, including transfer laparotomy operation in 8 cases; underwent conventional open cholecystectomy in 103 cases. Postoperative complications occurred in 49 cases, the complication rate was 12.69%, including incision infection, pulmonary infection, acute urinary retention, urinary tract infection, biliary fistula and so on. Three hundreds and eighty- four cases were cured, 2 cases died, for cholecystolithiasis complicated with severe acute cholangitis, died from multi organ failure in 3 days after operation. Conclusions The clinical characteristics of elderly calculous cholecystitis is unique. To strictly grasp the operation indication, selection of operation time, take individual operation method with the disease, and strengthen treatment of perioperative period are the key to improve the cure rate and the operation success rate of elderly cholecystitis.