老年人急性非结石性胆囊炎临床特点与外科治疗  

Clinical features and surgical treatment of acute acaculous cholecystitis in the aged

作　　者：张建新[1] 王旭青[1] 瞿建国[1] 程国祚[1] 

机构地区：[1]江苏省镇江医学院附属医院普外科,212001

出　　处：《肝胆胰外科杂志》2000年第1期32-34,共3页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的 :探讨老年人急性非结石性胆囊炎 (Acute acalculous cholecystitis,AAC)临床特点与最佳手术时机。方法 :通过设立严格的病例对照 ,比较了 5 2例老年人 AAC和急性结石性胆囊炎 (Acute calculouscholecystitis,ACC)的并存病、胆囊病理改变及术后结果 ;并对不同手术时机的老年人 AAC胆囊病变与术后结果进行比较。结果 :与老年人 ACC相比 ,AAC患者以心血管疾病为主的并存病明显增多 (P<0 .0 0 1) ;胆囊化脓、坏疽与穿孔率明显增高 (P值 <0 .0 1,<0 .0 0 1,<0 .0 5 ) ;术后并发症发生率明显上升 (P<0 .0 0 1)。病死率无显著差异 (P>0 .0 5 )。发病 48小时以上手术的 AAC胆囊坏疽与穿孔率及术后并发症发生率与病死率均较 48小时内手术者明显增高 (P值分别 <0 .0 0 1,<0 .0 0 1,<0 .0 5 )。结论 :老年人 AAC并存病多、胆囊病变重、术后并发症发生率高 ;宜在症状出现 48小时内手术治疗。Objective:To evaluate the clinical features and optimal timing of operation for acute acalculous cholecystitis in the aged.Methods:A case-control study of 52 patients with AAC and acute calculous cholecystitis(ACC) was undertaken.Their coexisting diseases,gallbladder pathology,postoperative morbidity and mortality were compared.The gallbladder pathology, postoperative morbidity and mortality of patients with AAC operated in different timing of surgery were compared.Results:Incomparison to ACC,the AAC had higher incidence of coexisting diseases(P<0.001),suppuration(P<0.01),gangrene(P<0.001) and perforation (P<0.05) as well as significantly higher morbidity(P<0.001).95% of cases with AAC who underwent operation more than 48 hours after the onset of symptoms sufferedg gangernt and perforation,conversely only 18% of cases operated within 48 hours had gangerne and perfortion(P<0.001).The morbidity and mortality of patients with AAC operated within 48 hours were 15.15% and 3.03%, respectively,in contrast to 68.42% and 31.58% in patients operated more than 48 hours(P<0.001 and P<0.05).Conclusions: In comparison to ACC,the AAC in the elderly has a higher incidence of coexisting diseases,gangrene and perforation as well as higher morbidity.Operation within 48 hours is necessary for AAC in the elderly patients. [FK(WB00001。5]

关 键 词：非结石性 胆囊炎 外科手术 治疗 

分 类 号：R574[医药卫生—消化系统]