老年人胆道再次手术处理体会（附34例报告）  

Study on Treatment of Biliary Tract Reoperation in Aged Patients ： A report of 34 Cases

作　　者：吕清泉[1] 刘权陷[2] 

机构地区：[1]武汉市汉口医院普外科,湖北武汉430012 [2]武汉大学中南医院普外科,湖北武汉430071

出　　处：《医学新知》2009年第3期141-144,共4页New Medicine

摘　　要：目的探讨老年人再次胆道手术的综合处理办法。方法分析2002年6月-2008年6月收治的34例60岁以上胆道再次手术的临床资料。结果急症再次胆道手术11例（32．4％）。主要原因是初次胆道术后胆漏、感染。择期再次胆道手术23例（67．6％），主要原因是胆总管残留或结石复发。术后并发症主要有手术部位感染、肺炎、肺不张、心功能衰竭、腹腔感染等。结论在处理老年患者再次手术问题时要注意以下几点：①再次手术时术前正确估计病情，充分认识胆道疾患的复杂性和难治性，并作详尽的辅助检查，以减少手术盲目性；②采取合理的手术方式，尽可能彻底根治疾病；③重视老年患者并存病的围手术期处理，重视术后并发症的处理。Objective To investigate integrated approaches for biliary tract reoperation in aged patients. Methods Clinical data of 34 biliary tract reoperations in patients over the age of 60 from June 2002 to June 2008 were retrospectively reviewed and analyzed. Results Emergency reoperation of biliary tract was given to 11 cases, accounting for 32.4%. The major reasons included bile leakage after the initial operation and biliary tract infection. Optional reoperation was performed in 23 cases, accounting for 67.6%, mainly due to residual or recurrent common bile duct stones. Main postoperative complications were surgical site infection, pneumonia, atelectasis, heart failure and intra -abdominal infections. Conclusion Before the biliary tract reoperation for aged patients, attention should be paid to the following points： 1. An accurate assessment of the disease, a full cognition of the complexity and intractability of biliary tract disorders, and a careful assistant examination should be made in order to avoid the blindness of the reoperation. 2. Reasonable surgical approach should be adoptted to completely cure the disease. 3. Importance shoule be attached to coexistence of diseases in aged patients perioperative treatment, and the treatment of postoperative complications.

关 键 词：老年人 胆道 再次手术 

分 类 号：R657.4[医药卫生—外科学]