老年肥胖胆囊炎患者的临床特点及诊治经验  

The Clinical Features,Diagnosis and Treatment of Cholecystitis in the Old Obese Patients

作　　者：李坤平[1] 林帆[2] 古维立[2] 徐波[2] 范少峰[2] 赖越元[2] 林春明[2] 

机构地区：[1]广州医学院,广州510182 [2]广州医学院附属广州市第一人民医院肝胆外科,广州510180

出　　处：《中国现代手术学杂志》2011年第4期256-258,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨老年肥胖患者胆囊炎的临床特点。方法我科2008年1月～2011年3月收治898例胆囊炎患者,其中129例为老年肥胖患者,129例中行保守治疗55例,余74例行手术治疗,其中胆囊切除术67例,胆囊切除+胆囊造瘘术5例,胆囊大部分切除术2例。结果 74例手术患者术后出现胆漏3例,出血1例,伤口脂肪液化2例,均治愈。55例保守治疗患者中2例并发肝功能衰竭死亡。伴有糖尿病及BMI≥28的患者,其手术时间长,术中出血量大、住院时间久,并发症发生率高(P<0.05)。结论老年,尤其是肥胖患者,可能是慢性胆囊炎急性发作、胆囊结石的危险因素之一;其临床症状不典型,具有较强的隐蔽性,并发症相对较多,预后相对较差,应该及早诊治。Objective To investigate the clinical characteristics of the old obese patients of cholecystitis. Methods The clinical data of 129 old obese cases were retrospectively studied, in whom 55 received conservative treatment and 74 cases received operations （ routine cholecystectomy in 67, gallbladder resection ＋ cholecystomy in 5 and partial cholecystectomy in 2）. Results In 74 surgical cases, there were 3 cases complicated with bile leakage, 1 with bleeding and 2 with wound seroma, and all got cured. In 55 cases of con- servative treatment, there were 2 cases suffered from the liver function failure and died later. It showed longer operative time, more bleeding, longer hospital stay and higher complication rate in the diabetes and （or） BMI ≥28 patients. Conclusion The aged, especially in the obese patients, may be one of the risk factors for acute exacerbation of chronic cholecystitis and gallstone; clinical symptoms may be not typical with a strong hidden of advance complications, relative risks of certain difficulties brought on the diagnosis and treatment which needs closer attentions.

关 键 词：胆囊炎 超重 老年人 

分 类 号：R657.4[医药卫生—外科学]