70岁以上胆石症急性发作的特点及治疗对策  

THE CLINICAL CHARACTARISTICS AND STRATEGIES FOR SURGICAL TREATMENT OF THE ELDERLY PATIENTS WITH ACUTE ONSET OF CHOLELITHIASIS

作　　者：俞建平[1] 钱岳荣[1] 

机构地区：[1]上海医科大学附属金山医院

出　　处：《现代康复》1998年第6期612-613,共2页Modern Rehabilitation

摘　　要：目的：总结７０岁以上胆石症急性发作的外科手术治疗经验。方法：回顾性分析５２例手术病人。结果：手术治疗７０岁以上胆石症急性发作５２例，其中急诊手术３４例，急性胆道感染控制后择期手术１８例，死亡２例。手术病死率３．８５％，急性手术组病死率５．８８％，择期组为零。胆囊切除１８例，胆总管切开引流８例，胆囊切除加胆总管切开引流２０例，胆囊造瘘５例，胆总管十二指肠吻合１例。其中胆总管结石２４例，治愈１８例，胆道残余结石２例。结论：其特点是临床表现不典型，易误诊，内科夹杂症多，并发症率高。但年龄决不是手术的禁忌证，如能正确把握手术适应证和恰当的手术时机，重视围手术期的处理，纠治各种夹杂症，采用有效而简单的手术方式。Objective to evaluate the experience in the surgical treatment of the elderly patients(≥70years of age)with acute onset of cholelithiasis (AOC).Methods:52 patients underwent operations were retrospectively studied.Results:34 cases(65%) underwent emergency operations when the acute biliary infection had been controlled.18 cases underwent cholecystectomy,28 cases underwent choledochostomy or plus cholecystectomy.24 patients were ill with common bile duct stones,including 8 cases with AOSC,14 cases with gangrenous or perforating cholecystitis.48 patients were cured.Conclusion:The characteristics are atypical menifestation,predispose to delay the diagnosis,more associated with chronic diseases and higher emergency operative mortality.However,the age is nocontraindication of operation.The satisfactory results can be achieved granted the indication and time for the operation are selected properly,the management of the perioperative period is much concerned as well as the easy-going effective way of the operation is taken.

关 键 词：老年 胆石症 急性发作期 手术治疗 手术方法 

分 类 号：R657.42[医药卫生—外科学]