197例老年胆道疾病诊治体会  

Experience in diagnosis and treatment of biliary diseases in 197 elderly patients

作　　者：张宗明[1] 刘卓[1] 魏文平[1] 田祖豪[1] 张翀[1] 刘立民[1] 于宏伟 万柏江[1] 邓海[1] 谢朝辉[2] 

机构地区：[1]首都医科大学北京电力医院普外科,北京100073 [2]首都医科大学北京电力医院健康管理部,北京100073

出　　处：《腹部外科》2015年第5期337-341,370,共6页Journal of Abdominal Surgery

基　　金：国家电网公司科技基金资助项目（SGHB0000AJJS1400182）

摘　　要：目的 探讨老年胆道疾病的临床特点和治疗方法,以期提高老年胆道疾病的诊治水平.方法 收集2013年6月至2015年5月收治的197例老年胆道疾病病人的临床资料,对其年龄、病种、并存病、实验室检查、手术方式、术后并发症和治疗效果进行分析.结果 197例老年胆道疾病病人的平均年龄是（74.2＆#177;8.9）岁,患有胆囊结石、急性胆囊炎、胆道肿瘤等10种胆道疾病中的一种者67例、两种者130例.71.57％（141/197）病人有高血压、冠心病、糖尿病等13种并存病中之1～6种.手术治疗117例,手术方式有腹腔镜胆囊切除、胰十二指肠切除、肝门部胆管癌根治术等9种术式;术后并发症有肺部感染、低钾血症、切口脂肪液化等9种类型,发生率为27.35％（32/117）,以肺部感染占比最高,为37.50％（12/32）.非手术治疗80例,主要方法是抗感染、对症、支持治疗.手术组治愈率为95.73％（112/117）,非手术组治愈率为92.50％（74/80）,两组疗效差异无统计学意义（P＞0.05）.结论 老年胆道疾病病人手术是安全可行的;根据病人的病情需要,积极控制并存病,严格掌握手术指征和时机,合理选择手术方式,加强围手术期治疗,及时处理术后并发症,是提高老年胆道疾病病人手术治疗效果的关键.Objective To explore the clinical characteristics and treatment of biliary diseases in elderly patients, so as to improve the diagnosis and treatment of biliary diseases. Methods The clinical data of 197 elderly patients with biliary diseases were collected from June 2013 to May 2015 in our hospital. The age, disease type, coexisting diseases, laboratory examinations, postoperative complications and efficacy were analyzed. Results The average age of 197 patients with biliary diseases was 74. 2 ±8.9 years old. There were 67 cases of one type of the 10 kinds of biliary diseases, such as gall- bladder stones, acute cholecystitis, biliary tract cancer, etc. Another 130 cases suffered from 2 types of the biliary diseases. 71.57% （141/197） patients with 1-6 types of the 13 kinds of coexisting diseases, such as hypertension, coronary heart disease, diabetes, etc. 117 cases underwent surgical treatment, with the 9 kinds of surgical methods, such as laparoscopic cholecystectomy, pancreaticoduode- nectomy, radical resection of hilar cholangiocarcinoma, etc. The 9 kinds of postoperative complications happened, including pulmonary infection, low serum potassium, incision fat liquefaction, etc. The incidence of postoperative complications was 27. 35 % （32/117）, with 37. 50% （12/32） pulmonary infection rate as the highest. Eighty cases underwent non-operative treatments, with the main therapy being anti-infection, symptomatic and supportive treatment, etc. The curative rate was 95.73 % （112/ 117） in surgical group and 92. 50% （74/80） in non-surgical group with the difference being not significant between the two groups （P〈0. 05）. Conclusions Surgical treatment of elderly patients with biliary diseases is safe and feasible. According to the patients conditions, to actively control the coexisting diseases, strictly hold the surgical indications and timing, reasonably choose surgical approaches, strengthen the perioperative treatment, timely treat the postoperative complications, are the key to improve

关 键 词：胆道疾病 老年 手术治疗 非手术治疗 

分 类 号：R657.4[医药卫生—外科学]