AIM: To evaluate clinical presentation, etiology, compli-cations and response to treatment in elderly patients with acute cholangitis.METHODS: Demographics, etiology of biliary obstruc-tion, clinical features, complic...AIM: To evaluate clinical presentation, etiology, compli-cations and response to treatment in elderly patients with acute cholangitis.METHODS: Demographics, etiology of biliary obstruc-tion, clinical features, complications and associated systemic diseases of 175 patients with acute cholangitis were recorded. Endoscopic biliary drainage was performed using nasobiliary drain or stent. The complications related to ERCP, success of biliary drainage, morbidity, mortality and length of hospital stay were evaluated. RESULTS: Of 175 patients, 52 aged ≥ 60 years (groupⅠ, age < 60 years; group Ⅱ, age ≥ 60 years) and 105 were men. Fever was present in 38 of 52 patients of group Ⅱ compared to 120 of 123 in groupⅠ. High fever (fever ≥ 38.0℃) was more common in groupⅠ(118/120 vs 18/38). Hypotension (5/123 vs 13/52), altered sensorium (3/123 vs 19/52), peritonism (22/123 vs 14/52), renal failure (5/123 vs 14/52) and associated comorbid diseases (4/123 vs 21/52) were more common in group Ⅱ. Biliopancreatic malignancy was a common cause of biliary obstruction in group Ⅱ (n = 34) and benign diseases in groupⅠ(n = 120). Indications for biliary drainage were any one of the following either singly or in combination: a fever of ≥ 38.0℃ (n = 136), hypotension (n = 18), peritonism (n = 36), altered sensorium (n = 22), and failure to improve within 72 h of conservative management (n = 22). High grade fever was more common indication of biliary drainage in groupⅠand hypotension, altered sensorium, peritonism and failure to improve within 72 h of conservative management were more common indications in group Ⅱ. Endoscopic biliary drainage was achieved in 172 patients (nasobiliary drain: 56 groupⅠ, 24 group Ⅱ, stent: 64 groupⅠ, 28 group Ⅱ) without any significant age related difference in the success rate. Abdominalpain, fever, jaundice, hypotension, altered sensorium, peritonism and renal failure improved after median time of 5 d in 120 patients in groupⅠ(2-15 d) compared to 10 d in 47 patients of group Ⅱ (3-20 d). Normalization of leucocyte count was seen after a median time of 7 d (3-20 d) in 120 patients in groupⅠcompared to 15 d (5-26 d) in 47 patients in group Ⅱ. There were no ERCP related complications in either group. Five patients (carcinoma gallbladder n = 3, CBD stones n = 2) died in group Ⅱ and they had undergone biliary drainage after failure of response to conservative management for 72 h. There was a higher mortality in patients in group Ⅱ despite successful biliary drainage (0/120 vs 5 /52). Length of hospital stay was longer in group Ⅱ patients (16.4 ± 5.6, 7-30 d) than in groupⅠpatients (8.2 ± 2.4, 7-20 d).CONCLUSION: Elderly patients with acute cholangitis have a high incidence of severe cholangitis, concomitant medical illnesses, hypotension, altered sensorium, peritonism, renal failure and higher mortality even after successful biliary drainage.展开更多
AIM:To evaluate the outcome of laparoscopic cholecystectomy(LC)in patients aged 80 years and older. METHODS:A total of 353 patients aged 65 to 79 years(group 1)and 35 patients aged 80 years and older(group 2)underwent...AIM:To evaluate the outcome of laparoscopic cholecystectomy(LC)in patients aged 80 years and older. METHODS:A total of 353 patients aged 65 to 79 years(group 1)and 35 patients aged 80 years and older(group 2)underwent LC.Patients were further classified into two other groups:those with uncomplicated gallbladder disease(group A)or those with complicated gallbladder disease(group B). RESULTS:There were no significant differences between the age groups(groups 1 and 2)with respect to clinical characteristics such as age,gender,comorbid disease,or disease presentation.Mean operative time,conversion rate,and the incidence of major postoperative complications were similar in groups 1 and 2.However,the percentage of high-risk patients was significantly higher in group 2 than in group 1 (20.0%vs 5.7%,P<0.01).Group A comprised 322 patients with a mean age of 71.0±5.3 years,and group B comprised 51 patients with a mean age of 69.9±4.8 years.In group B,mean operative time (78.4±49.3 min vs 58.3±35.8 min,P<0.01),mean postoperative hospital stay(7.9±6.5 d vs 5.0±3.7 d, P<0.01),and the incidence of major postoperative complications(9.8%vs 3.1%,P<0.05)were significantly greater than in group A.The conversion rate tended to be higher in group B,but this difference was not significant. CONCLUSION:Perioperative outcomes in elderly patients who underwent LC seem to be influenced by the severity of gallbladder disease,and not by chronologic age.In octogenarians,LC should be performed at an earlier,uncomplicated stage of the disease whenever possible to improve perioperative outcomes.展开更多
AIM： To study whether H pylon are associated with chronic cholecystitis. METHODS： The subjects were divided into three groups： H pylori-infected cholecystitis group, H pylorinegative cholecystitis group and control...AIM： To study whether H pylon are associated with chronic cholecystitis. METHODS： The subjects were divided into three groups： H pylori-infected cholecystitis group, H pylorinegative cholecystitis group and control group. Pathologic changes of the gallbladder were observed by optic and electronic microscopes and the levels of interleukin-1, 6 and 8 （IL-1, 6 and 8） were detected by radioimmunoassay. RESULTS： Histological evidence of chronic cholecystitis including degeneration, necrosis, inflammatory cell infiltration, were found in the region where H pylori colonized. Levels of IL-1, 6 and 8 in gallbladder mucosa homogenates were significantly higher in H py/oriinfected cholecystitis group than those in Hpylorinegative cholecystitis group and control group. CONCLUSION： H pylon infection may be related to cholecystitis.展开更多
文摘AIM: To evaluate clinical presentation, etiology, compli-cations and response to treatment in elderly patients with acute cholangitis.METHODS: Demographics, etiology of biliary obstruc-tion, clinical features, complications and associated systemic diseases of 175 patients with acute cholangitis were recorded. Endoscopic biliary drainage was performed using nasobiliary drain or stent. The complications related to ERCP, success of biliary drainage, morbidity, mortality and length of hospital stay were evaluated. RESULTS: Of 175 patients, 52 aged ≥ 60 years (groupⅠ, age < 60 years; group Ⅱ, age ≥ 60 years) and 105 were men. Fever was present in 38 of 52 patients of group Ⅱ compared to 120 of 123 in groupⅠ. High fever (fever ≥ 38.0℃) was more common in groupⅠ(118/120 vs 18/38). Hypotension (5/123 vs 13/52), altered sensorium (3/123 vs 19/52), peritonism (22/123 vs 14/52), renal failure (5/123 vs 14/52) and associated comorbid diseases (4/123 vs 21/52) were more common in group Ⅱ. Biliopancreatic malignancy was a common cause of biliary obstruction in group Ⅱ (n = 34) and benign diseases in groupⅠ(n = 120). Indications for biliary drainage were any one of the following either singly or in combination: a fever of ≥ 38.0℃ (n = 136), hypotension (n = 18), peritonism (n = 36), altered sensorium (n = 22), and failure to improve within 72 h of conservative management (n = 22). High grade fever was more common indication of biliary drainage in groupⅠand hypotension, altered sensorium, peritonism and failure to improve within 72 h of conservative management were more common indications in group Ⅱ. Endoscopic biliary drainage was achieved in 172 patients (nasobiliary drain: 56 groupⅠ, 24 group Ⅱ, stent: 64 groupⅠ, 28 group Ⅱ) without any significant age related difference in the success rate. Abdominalpain, fever, jaundice, hypotension, altered sensorium, peritonism and renal failure improved after median time of 5 d in 120 patients in groupⅠ(2-15 d) compared to 10 d in 47 patients of group Ⅱ (3-20 d). Normalization of leucocyte count was seen after a median time of 7 d (3-20 d) in 120 patients in groupⅠcompared to 15 d (5-26 d) in 47 patients in group Ⅱ. There were no ERCP related complications in either group. Five patients (carcinoma gallbladder n = 3, CBD stones n = 2) died in group Ⅱ and they had undergone biliary drainage after failure of response to conservative management for 72 h. There was a higher mortality in patients in group Ⅱ despite successful biliary drainage (0/120 vs 5 /52). Length of hospital stay was longer in group Ⅱ patients (16.4 ± 5.6, 7-30 d) than in groupⅠpatients (8.2 ± 2.4, 7-20 d).CONCLUSION: Elderly patients with acute cholangitis have a high incidence of severe cholangitis, concomitant medical illnesses, hypotension, altered sensorium, peritonism, renal failure and higher mortality even after successful biliary drainage.
文摘AIM:To evaluate the outcome of laparoscopic cholecystectomy(LC)in patients aged 80 years and older. METHODS:A total of 353 patients aged 65 to 79 years(group 1)and 35 patients aged 80 years and older(group 2)underwent LC.Patients were further classified into two other groups:those with uncomplicated gallbladder disease(group A)or those with complicated gallbladder disease(group B). RESULTS:There were no significant differences between the age groups(groups 1 and 2)with respect to clinical characteristics such as age,gender,comorbid disease,or disease presentation.Mean operative time,conversion rate,and the incidence of major postoperative complications were similar in groups 1 and 2.However,the percentage of high-risk patients was significantly higher in group 2 than in group 1 (20.0%vs 5.7%,P<0.01).Group A comprised 322 patients with a mean age of 71.0±5.3 years,and group B comprised 51 patients with a mean age of 69.9±4.8 years.In group B,mean operative time (78.4±49.3 min vs 58.3±35.8 min,P<0.01),mean postoperative hospital stay(7.9±6.5 d vs 5.0±3.7 d, P<0.01),and the incidence of major postoperative complications(9.8%vs 3.1%,P<0.05)were significantly greater than in group A.The conversion rate tended to be higher in group B,but this difference was not significant. CONCLUSION:Perioperative outcomes in elderly patients who underwent LC seem to be influenced by the severity of gallbladder disease,and not by chronologic age.In octogenarians,LC should be performed at an earlier,uncomplicated stage of the disease whenever possible to improve perioperative outcomes.
基金Supported by the National Natural Science Foundation of China, No. 39970039
文摘AIM： To study whether H pylon are associated with chronic cholecystitis. METHODS： The subjects were divided into three groups： H pylori-infected cholecystitis group, H pylorinegative cholecystitis group and control group. Pathologic changes of the gallbladder were observed by optic and electronic microscopes and the levels of interleukin-1, 6 and 8 （IL-1, 6 and 8） were detected by radioimmunoassay. RESULTS： Histological evidence of chronic cholecystitis including degeneration, necrosis, inflammatory cell infiltration, were found in the region where H pylori colonized. Levels of IL-1, 6 and 8 in gallbladder mucosa homogenates were significantly higher in H py/oriinfected cholecystitis group than those in Hpylorinegative cholecystitis group and control group. CONCLUSION： H pylon infection may be related to cholecystitis.
