90岁以上超高龄胆总管结石患者治疗的临床分析

Clinical analysis of the treatment of choledocholithiasis in the elderly over 90 years old

目的探讨90岁以上超高龄胆总管结石患者的临床治疗。方法回顾性分析我院2018年7月至2019年6月收治的90岁以上超高龄胆总管结石患者26例,总结其临床特点和治疗选择,并结合文献进行研究。结果超高龄患者往往合并症多,保守治疗15例中,1例死亡,2例保守效果差且不同意手术治疗转入当地医院治疗,余12例患者均缓解,顺利出院。手术治疗11例患者均好转出院,无死亡病例,术后1例患者出现皮下气肿,1例LCBDE患者出现胆瘘,1例出现肺部感染,1例出现尿潴留,1例LCBDE及1例OCBED患者出现术后谵妄症状。术后2例OCBED及6例LCBDE复查行T管造影均无结石残留,顺利拔除T管。结论90岁以上的超高龄胆总管结石患者往往病情复杂,风险高,其治疗选择受多方面因素的影响,药物治疗、内镜治疗及外科手术治疗应根据患者的具体情况实施个体化治疗。

Objective To investigate the clinical treatment of common bile duct stones in the elderly over 90 years old.Methods A retrospective analysis was made of 26 cases of choledocholithiasis in the elderly over 90 years old in our hospital from July 2018 to June 2019.The clinical characteristics and treatment options were summarized and the literature was reviewed.Results Elderly patients often had more complications.Among 15 conservative patients,1 died,2 conservative patients disagreed with the operation and transferred to local hospitals.The remaining 12 patients were relieved and discharged smoothly.Eleven patients who underwent operation were discharged from hospital with no death.One patient developed subcutaneous emphysema,one LCBDE patient developed biliary fistula,one lung infection,one urinary retention,one LCBDE and one OCBED patient developed delirium symptoms.After operation,2 cases of OCBED and 6 cases of LCBDE underwent T-tube angiography without residual stones,and T-tube was successfully removed.Conclusion The patients over 90 years old with common bile duct stones are often complicated and at high risk.The choice of treatment is influenced by many factors.Medication,endoscopic treatment and surgical treatment should be individualized according to the specific conditions of patients.