高龄患者急性重症胆囊炎的处理(附52例报道)  

Treatment of acute severe cholecystitis in elderly patients:report of 52 cases

作　　者：王雨[1] 刘湘玲[2] 阎勇[2] 戴睿武[2] 

机构地区：[1]成都军区总医院妇产科,成都610083 [2]成都军区总医院全军普外中心,成都610083

出　　处：《西南国防医药》2011年第12期1311-1313,共3页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的回顾研究高龄患者急性重症胆囊炎的治疗效果。方法 52例急性重症胆囊炎的高龄患者分别进行急诊手术(10例)、B超引导下经皮经肝穿刺胆囊置管引流+手术切除(39例)及B超引导下经皮经肝穿刺胆囊置管引流(3例),研究其治疗效果和并发症。结果 49例手术治疗患者无手术死亡;42例经PTGD治疗患者无出血、气胸、胆漏、胆汁性腹膜炎等并发症发生,治疗后1～3 d症状明显缓解。结论对于全身情况稳定,胆囊壁厚度≤0.5 cm的患者宜行急诊手术治疗;对胆囊壁厚度>0.5 cm,全身情况差或有严重内科疾病的患者宜先采用B超引导下经皮经肝穿刺胆囊置管引流,再行手术治疗的方案。Objective To analyze retrospectively the therapeutic effects on elderly patients with acute severe cholecystitis.Methods Among the 52 elderly patients with acute severe cholecystitis,10 ones received the emergent operation,39 received the type-B ultrasonic percutaneous transhepatic gallbladder drainage（PTGD）plus exairesis and 3 received only the type-B ultrasonic PTGD.Their therapeutic effects and complications were studied.Results There were no dead cases among the 49 patients receiving the operation.There were no complications of bleeding,pneumothorax,bile leak and bile peritonitis among the 42 cases receiving the PTGD.And their symptoms were obviously relieved 1-3 d after the treatment.Conclusion It is suitable for the elderly patients with stable physical status and the thickness of gallbladder wall less than 0.5 cm to receive the operation.For the patients with the thickness of gallbladder more than 0.5 cm,bad physical status or severe morbus internus,it is suitable to receive the operation after the treatment of PTGD.

关 键 词：高龄 胆囊切除 经皮经肝穿刺胆囊置管引流 急性重症胆囊炎 

分 类 号：R575.6[医药卫生—消化系统]