老年病人急性无结石性胆囊炎外科治疗体会

Analysis of surgical treatment of acute acalculous cholecystitis in elderly patients

目的探讨老年急性无结石性胆囊炎(AAC)病人的治疗方法。方法回顾2010年1月至2015年6月老年AAC病人46例的临床资料,22例一期手术,24例行超声引导下经皮经肝胆囊穿刺置管引流术(PTGD)后18例行二期手术。结果一期手术组术后入ICU治疗20例,切口感染3例,肺部并发症16例,心脏并发症12例,多器官功能衰竭5例,1例死亡,3例自动出院。二期手术组术后入ICU治疗8例,切口感染2例,肺部并发症7例,心脏并发症3例,多器官功能衰竭1例,无死亡或自动出院病人。二期手术组术后入ICU率,肺部并发症与心脏并发症发生率明显低于一期手术组,差异有统计学意义(P<0.05)。2组在切口感染率、术后多器官功能衰竭率、死亡与自动出院率的比较差异无统计学意义(P>0.05)。结论 PTGD术后二期手术是治疗老年AAC一种较为安全的方法,对于不能耐受手术的高龄AAC,PTGD可作为最终治疗方案。

Objective To study surgical treatment of acute acalculous cholecystitis（AAC） in elderly patients.Methods The clinical data of 46 aged patients with AAC who underwent surgical treatment from January 2010 to June 2015 were analyzed retrospectively.There were 22 patients who underwent one-stage operation and 18 patients who underwent two-stage operation after percutaneous transhepatic gallbladder drainage（PTGD） three months ago.There were 6 patients who only underwent PTGD.Results There were 20 patients administered into the postoperative ICU,3 cases of incision infection,16 cases of pulmonary complications,12 cases of cardiac complications,5 cases of multiple organ failure,1 case of death and 3 cases of automatic discharge in one-stage operation group,compared with 8,2,7,3,1,0,0 in two-stage operation group.There were significant differences in ICU occupancy rate,pulmonary complications rate and cardiac complications rate between one-stage operation group and two-stage operation group（P〈0.05）.Conclusions Two-stage operation after PTGD is a safe method for treatment for AAC in aged patients.PTGD is an end-stage treatment of AAC in aged patients who can tolerate operation.