65岁以上急性结石性胆囊炎患者的临床诊治体会

郭欣; 吕小慧; 石栋立; 李宁宇; 陈芦斌

doi:10.3969/j.issn.1001-5256.2016.07.028

65岁以上急性结石性胆囊炎患者的临床诊治体会

DOI: 10.3969/j.issn.1001-5256.2016.07.028

解放军第四五一医院腔镜外科

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中图分类号: R657.41
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出版历程
- 出版日期: 2016-07-20

Experience in clinical diagnosis and treatment of patients aged >65 years with acute calculous cholecystitis

摘要

摘要: 目的探讨急性结石性胆囊炎老年患者的临床诊治特点及方法。方法回顾性分析2012年6月-2015年6月于解放军第四五一医院诊断为急性结石性胆囊炎老年患者的临床资料。所有患者入院后均采取禁食、心电监护、抗感染、纠正体液平衡、维持血压血糖稳定等措施,根据患者病情选择腹腔镜胆囊切除术、开腹胆囊切除术和开腹胆囊切除术+胆总管探查术。结果共收集129例老年患者,其中急性结石性胆囊炎119例,胆囊结石伴胆囊黏膜腺瘤样增生2例,化脓性胆囊炎6例,胆囊坏疽2例;纳入患者中52例合并至少1种以上内科疾病。67例患者症状无明显改善而行急诊手术;62例症状缓解,择期行手术治疗。共108例患者行腹腔镜胆囊切除术,9例腹腔镜中转开腹胆囊切除术,9例开腹胆囊切除术+胆总管探查术。所有手术均获得成功,患者术后痊愈出院,无死亡病例。结论老年患者急性结石性胆囊炎病情危重,常伴多种内科疾病,而腹腔镜胆囊切除术是最常用的治疗方式。临床医生应充分完善术前准备,重视围手术期处理,准确把握手术指征和时机。
- 胆囊炎,急性 /
- 治疗 /
- 老年人
Abstract: Objective To investigate the features and methods of clinical diagnosis and treatment of elderly patients with acute calculous cholecystitis. Methods A retrospective analysis was performed for the clinical data of elderly patients who were diagnosed with acute calculous cholecystitis in 451 Hospital of PLA from June 2012 to June 2015. After admission,all patients received fasting treatment,electrocardiographic monitoring,anti- infective therapy,and maintenance of body fluid balance and stable blood pressure and glucose. According to patients condition choose laparoscopic cholecystectomy open cholecystectomy,open cholecystectomy and common bile duct exploration. Results A total of 129 patients were enrolled; among these patients,119 had acute calculous cholecystitis,2 had gallstones with adenomatous hyperplasia of the gallbladder mucosa,6 had pyogenic cholecystitis,and 2 had gallbladder gangrene. Among the patients enrolled,52 were complicated by at least one internal disease. Among them,67 underwent emergency surgery since there were no significant improvements in symptoms,and 62 showed relief of symptoms and underwent surgical treatment at other times. Of all patients,108 underwent laparoscopic cholecystectomy,9 underwent laparoscopy and were converted to open cholecystectomy,and 9 underwent open cholecystectomy and common bile duct exploration. All the surgeries were successful and all the patients were cured and discharged. There were no deaths. Conclusion Elderly patients with acute calculous cholecystitis are in a critical condition and often complicated by various internal diseases. Laparoscopic cholecystectomy is the most commonly used therapeutic method. Clinicians should be fully prepared before surgery,take the perioperative management seriously,and accurately judge the surgical indications and timing.
- cholecystitis /
- acute /
- therapy

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