老年急性结石胆囊炎患者210例外科治疗策略探讨
王晓刚1 ，李建辉2
（1.陕西省蒲城县医院普外科，陕西 渭南，715500；2.陕西省人民医院肿瘤科，陕西 西安，710068）
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摘要：
目的 总结老年急性结石性胆囊炎的临床特点及治疗方案，分析手术时机和方式对患者预后的影响。方法 回顾性分析 2000年1月至2016年6月我院收治的210例年龄为60~87岁的老年急性结石性胆囊炎患者的临床资料，分析其病情特点、 治疗方法和并发症发生情况。结果 210例中，合并高血压97例（46.2%），冠心病178 例（84.8%），糖尿病36例（17.1%），陈旧性心肌梗塞15例（7.1%），支气管炎肺气肿32例（15.2%），脑梗塞19例（9.0%），同时合并两种以上疾病52例（24.8%）。保守治疗14例，死亡3例；行腹腔镜胆囊切除术56例（中转开腹3例），开腹胆囊切除术140 例，其中，胆囊大部切除术2例，胆囊切除加胆道探查术28例，193例治愈，死亡3例，伤口感染13例，肺部感染9例，平均住院时间为10~19 d。结论 老年胆囊炎并结石发病急，症状重，并发症多，临床容易误诊，手术风险较大，因此应仔细分析病情，选择合理的个性化治疗方案和手术时机，积极进行术前准备，是降低并发症和死亡率的关键。
关键词：老年人胆囊炎；结石；胆囊大部切除术
中图分类号：R657.4文献标志码：A文章编号：2096-1413(2017)14-0075-02
Surgery strategies analysis of 210 aged patients with acute calculous cholecystitis
WANG Xiao-gang 1, LI Jian-hui 2
(1. Department of General Surgery, People`s Hospital of Pucheng, Weinan 715500; 2. Department of Oncology,
Shaanxi Provincial People`s Hospital, Xi`an 710068, China)
ABSTRACT: Objective To summarize the clinical features of elderly patients with acute calculous cholecystitis and the treatment methods, and analyze the influence of operation time and methods on patients` prognosis. Methods The clinical data of 210 patients with acute calculous cholecystitis (aged 60-87) who were treated in our hospital from January 2000 to June 2016 were retrospectively analyzed, and the clinical feature, treatment methods and incidence of complications were observed. Results Among 210 cases, 97 cases (46.2%) suffered hypertension, 178 cases (84.8%) suffered coronary heart disease, 36 cases (17.1%) suffered diabetes, 15 cases (7.1%) suffered old myocardial infarction, 32 cases (15.2%) suffered bronchial pulmonary emphysema, 19 cases suffered cerebral infarction (9.0%), 52 cases complicated with at least 2 kinds of disease. Fourteen cases were treated with conservative treatment, 2 cases died; 56 cases were treated with laparoscopic gallbladder excision (3 cases were transferred to open cholecystectomy); of 140 cases who accepted open cholecystectomy, 2 cases treated with subtotal cystectomy, 28 cases were treated with common bile duct exploration; 193 cases were cured, 3 cases died; there were 13 cases of wound infection, 9 cases of pulmonary infection, the average hospitalization time was 10 to 19 days. Conclusion Elderly patients with calculous cholecystitis occurs urgently, with heavy symptoms and more complications and risks, which is easily misdiagnosed, so it is essential to analyze symptoms carefully, choose individualized treatment and operation time reasonably, and conduct active preoperative preparation, which is the key to reducing the complications and mortality.
KEYWORDS: elder patients with calculous cholecystitis; stone; subtotal cystectomy
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