老年人急性穿孔性胆囊炎的相关因素及治疗分析  

Analysis of risk factors and treatment for elderly acute perforated cholecystitis

作　　者：卓奇峰[1] 陈明良[1] 忻畅[1] 严焕军[1] 陈磊[1] 李定耀 

机构地区：[1]宁波大学医学院附属鄞州医院肝胆外科,浙江省宁波市315040

出　　处：《中华全科医学》2014年第8期1233-1235,1265,共4页Chinese Journal of General Practice

摘　　要：目的探讨老年人急性胆囊炎胆囊穿孔的危险因素及治疗方法。方法回顾性分析鄞州医院2007年1月—2012年1月收治的共277例65岁以上的老年急性胆囊炎患者接收胆囊切除术的一般情况、并存疾病、围手术期情况及转归等临床资料。其中并发穿孔31例(11.2%),急诊行胆囊切除术19例,胆囊穿刺引流后择期胆囊切除术12例。采用非条件Logistic回归分析方法筛选胆囊穿孔相关危险因素。穿孔组与非穿孔组进行比较,急诊胆囊切除组与穿刺引流组的围手术资料进行比较,数值变量采用t检验,分类变量采用χ2检验。结果穿孔组的年龄、糖尿病合并率、白细胞计数均高于非穿孔组(P<0.05),穿孔组体温显著高于非穿孔组(P<0.01),穿孔组的畏寒寒战的发生率显著高于非穿孔组(P<0.01)。因素分析糖尿病(P=0.02)、畏寒寒战(P=0.00)、体温(P=0.01)和白细胞计数(P=0.03)是影响胆囊穿孔的指标;急诊手术的并发症高于胆囊穿刺后择期手术组(切口感染P=0.00,肺不张及肺部感染P=0.03)。结论以体温(≥38.5℃)、畏寒寒战、白细胞计数升高(≥15.0×109/L),并存糖尿病基础疾病,来判断老年人急性胆囊炎穿孔是可行的。对于病情较重的老年患者,胆囊穿刺能明显减少术后的并发症发生率。Objective To investigate risk factors and treatment for elderly acute perforated cholecystitis. Methods The medical records of 277 patients over 65 years who received surgical treatment with the diagnosis of acute cholecystitis in our clinics between January 2007 and January 2012 were reviewed retrospectively. The demographic data of patients, co- morbidity status, perioperative status and postoperative status were analyzed. There were 31 （ 11.2% ） patients with the diagnosis of gallbladder perforation, 19 patients underwent urgent cholecystectomy, 12 patients underwent percutaneous drainage and cholecystectomy after stabilization. Univariate and multiple logistic regression analyses were performed to an- alyze the effects of variables that influenced gallbladder perforation. The demographic data between patients with gallblad- der perforation and that without perforation and perioperative data between patients who received urgent cbolecystectomy and patients who received percutaneous drainage was compared with student t test for numeric data, chi-square analysis for qualitative data. Results The age and the white blood ceil count of patients with gallbladder perforation was higher than that of without perforation（P 〈 0.05 ） ;diabetes comorbidity and chilis was more in patients with perforation than in that without（ P 〈 0.05 and P 〈 0.01 ） ;fever in patients with perforation was significantly higher than in patients without perforation（ P 〈 0.01 ）. Risk factors for elderly acute perforated cholecystitis included diabetes （ P = 0.02 ）, chills （ P = 0.00） , temperature （P = 0.01 ） and white blood cell count （P = 0.03 ） ; complications of urgent surgery were more than of percutaneous transhepatic gall bladder drainage before surgery （ incision infection P = 0.00, atelectasis and pulmonary infection P =0.03）. Conclusion Based on high temperature （ ≥38.5℃ ） ,chills,leukocytosis（ ≥15.0× 109/L） , comorbid conditions of diabetes, it seems possible to identify gal

关 键 词：急性胆囊炎 穿孔 老年 危险因素 胆囊切除术 

分 类 号：R657.41[医药卫生—外科学]