86例老年结石性胆囊炎的诊疗体会  

Diagnosis and treatment experience of 86 senile calculous cholecystitis

作　　者：万里明[1] 张思东[1] 唐德军[1] 

机构地区：[1]合肥市第三人民医院普外科,230022

出　　处：《安徽医学》2013年第6期745-746,共2页Anhui Medical Journal

摘　　要：目的探讨老年结石性胆囊炎的临床特点以及外科诊疗经验。方法回顾分析86例老年结石性胆囊炎的临床资料。结果 86例患者中,慢性胆囊炎35例,急性单纯性胆囊炎34例,急性化脓性胆囊炎3例,胆囊坏疽13例,胆囊癌1例。其中传统开腹单纯胆囊切除术46例,胆囊切除+胆总管探查T管引流术27例,胆囊切除+胆总管瘘口切除术1例,胆囊切除胆总管切开取石T管引流+肝左外叶切除术1例,胆囊切除胆总管切开取石T管引流+胆囊十二指肠瘘修补术1例,腔镜下胆囊切除术8例,腔镜下胆囊切除胆总管探查T管引流术2例。本组患者中痊愈84例,1例患者死于术后并发心肌梗死,1例患者胆囊癌放弃再手术出院。结论老年结石性胆囊炎起病急,病情进展快,有手术条件及指针者宜尽早手术治疗,手术风险可控,效果明显。Objective To explore the clinical characteristics and surgical treatments of senile calculous cholecystitis. Methods The clinical data of 86 senile calculous cholecystitis were analyzed retrospectively. Results Among all the 86 patients, there were 35 chronic choleeystitis, 34 acute simple cholecystitis, 3 acute suppurative choleeystitis, 13 acute gangrene cholecystitis, and 1 gallbladder carcinoma. Forty-six cases underwent simple open cholecystectomy, 27 cases underwent cholecystectomy＋T-tube drainage, 1 case underwent choleeystec- tomy plus resection of common duct fistula, 1 case had choleeystectomy and choledocholithotomy and T tube drainage plus hepatic left lateral lobectomy, 1 case had eholecystectomy and choledoeholithotomy and T tube drainage plus gallbladder duodenal fistula, 8 cases underwent la- paroscopic cholecystectomy, and 2 cases underwent laparoscopie cholecysteetomy and T-tube drainage. Among them, 84 patients recovered completely, 1 patient died of myocardial infarction and 1 case of gallbladder carcinoma patient gave up operation and got discharged. Conclu- sion The clinical manifestation of acute senile calculous cholecystitis can be characterized by acute onset and rapid progress. Surgical proce- dures should be performed early if patient＇s condition permitted. Surgical risks can be controlled and the effect is obvious.

关 键 词：老年结石性胆囊炎 外科手术 诊疗体会 

分 类 号：R657.4[医药卫生—外科学]