老年患者胆囊切除术的诊治与临床分析(1)
[摘要] 目的 探讨不同情况下老年人胆囊疾病的治疗方法。 方法 回顾性分析2010年1月～2011年12月本院收治的131例60岁以上老年胆囊疾病患者的临床资料，对不同情况下采用的个体化治疗方法进行比较。 结果 131例患者中，腹腔镜胆囊切除(LC)27例，直接开腹(OC)103例，B超引导下经皮经肝胆囊穿刺引流(PTCD)1例。治愈129例，好转2例。 结论 对胆囊疾病老年患者，术前应全面掌握全身情况，认真分析胆囊的局部条件及病变性质，采用个体化治疗，可达到安全、微创治疗效果。胆囊疾患外科治疗必须完善围手术期处理，尽量避免急诊手术，减少并发症发生。
[关键词] 老年人；胆囊疾患；并发症；围术期
[中图分类号] R657.4 [文献标识码] B [文章编号] 1674-4721(2012)06(a)-0177-02
The diagnosis and treatment of elderly patients with cystic resection with experience
, 百拇医药
CHENG Zheng YU Changchun
Surgery Department of Wangjiang County Hospital in Anhui Province, Wangjiang 216200, China
[Abstract] Objective To explore the treatment of old gallbladder disease under different conditions. Methods The clinical material of 131 cases of 60 years or older patients with gallbladder disease in our hospital from January 2010 to December 2012 was analyzed retrospectively, individual therapy methods in different conditions were compared. Results Among 131 cases, 27 cases were given laparoscopic cystic resection (LC), 103 cases were given direct open resection (OC), B ultrasonic guided percutaneous drainage by liver biopsy gallbladder (PTCD) in 1 case. And 129 cases were cured, 2 cases improved obviously. Conclusion We should grasp the whole preoperative condition of elderly patients with gallbladder disease, careful analyze the local conditions and gallbladder lesion properties, and give the individual therapy, then we can achieve safety, minimally invasive treatment effect. Gallbladder disease surgical treatment must perfect the perioperative management, try to avoid emergency surgery, reduce the complications.
, 百拇医药
[Key words] Old people; Gallbladder diseases; Complication; Perioperative period
随着我国生活条件提高，医疗条件改善，人均寿命的延长，老年人的数量逐渐增加，随着人口老年化的趋势，发现近年来胆囊疾病发病呈增加趋势[1]，胆囊良性疾病是老年人的常见病和多发病之一，胆囊切除术是主要治疗方法。老年人因器官功能减退、免疫力低下、往往合并心、肺、肝、肾等多种疾病，使得老年性胆石症患者病情发展迅速，死亡率较年轻人高[2]。本科2010年1月～2011年12月共手术治疗823例胆石症患者，其中60岁以上131例，现报道如下：
1 资料与方法
1.1 一般资料
本组131例患者，男性29例，女性102例。年龄60～83岁，平均66.02岁。病史1 d～21年。胆囊结石伴急慢性胆囊炎118例(其中有右上腹疼痛、压痛及局限性腹膜炎体征者16例，伴发热23例)，化脓性胆囊炎伴胆管炎8例，胆囊息肉样变3例。术前合并心血管疾病74例，合并呼吸系统疾病29例，合并糖尿病34例，合并肝硬化、门脉高压17例，其他合并症11例。
, 百拇医药
1.2 手术方法
131例患者中，急诊手术16例；择期手术114例，其中含姑息性胆囊癌切除术1例；B超引导下经皮经肝胆囊穿刺引流(PTCD)1例。急诊手术和择期手术130例中，开腹胆囊切除术103例；腹腔镜胆囊切除(LC)27例。急诊胆囊切除因颈部结石嵌顿或颈部水肿较重，三胆管无法分辨，行逆行胆囊切除术。择期手术均采用顺逆结合方法行胆囊切除术。腹腔镜胆囊切除(LC)采用三孔法行胆囊切除。B超引导下经皮经肝胆囊穿刺引流(PTCD)是在B超引导下采用腔静脉穿刺导管经皮经肝胆囊穿刺引流。
2结果
全部患者治愈129例，好转2例，无死亡病例。治愈标准为胆囊已完全切除，随访半年以上症状消失。好转2例中，1例行姑息性胆囊癌切除术，术后3个月仍有上腹饱胀不适。另1例在B超引导下经皮经肝胆囊穿刺引流后合并胆囊结石，术后仍有上腹隐痛不适，但症状较前明显减轻。并发切口感染5例，其中脂肪液化3例，切口裂开2例，分别为血糖未控制到9 mmol/L以下1例，低蛋白血症1例，均经二次缝合、对症治疗后治愈；肺部感染8例(6例为急诊)；应激性溃疡1例(为急诊手术)；泌尿系感染6例；急性尿潴留6例(3例为急诊)。, 百拇医药(程铮 虞长春)
[关键词] 老年人；胆囊疾患；并发症；围术期
[中图分类号] R657.4 [文献标识码] B [文章编号] 1674-4721(2012)06(a)-0177-02
The diagnosis and treatment of elderly patients with cystic resection with experience
, 百拇医药
CHENG Zheng YU Changchun
Surgery Department of Wangjiang County Hospital in Anhui Province, Wangjiang 216200, China
[Abstract] Objective To explore the treatment of old gallbladder disease under different conditions. Methods The clinical material of 131 cases of 60 years or older patients with gallbladder disease in our hospital from January 2010 to December 2012 was analyzed retrospectively, individual therapy methods in different conditions were compared. Results Among 131 cases, 27 cases were given laparoscopic cystic resection (LC), 103 cases were given direct open resection (OC), B ultrasonic guided percutaneous drainage by liver biopsy gallbladder (PTCD) in 1 case. And 129 cases were cured, 2 cases improved obviously. Conclusion We should grasp the whole preoperative condition of elderly patients with gallbladder disease, careful analyze the local conditions and gallbladder lesion properties, and give the individual therapy, then we can achieve safety, minimally invasive treatment effect. Gallbladder disease surgical treatment must perfect the perioperative management, try to avoid emergency surgery, reduce the complications.
, 百拇医药
[Key words] Old people; Gallbladder diseases; Complication; Perioperative period
随着我国生活条件提高，医疗条件改善，人均寿命的延长，老年人的数量逐渐增加，随着人口老年化的趋势，发现近年来胆囊疾病发病呈增加趋势[1]，胆囊良性疾病是老年人的常见病和多发病之一，胆囊切除术是主要治疗方法。老年人因器官功能减退、免疫力低下、往往合并心、肺、肝、肾等多种疾病，使得老年性胆石症患者病情发展迅速，死亡率较年轻人高[2]。本科2010年1月～2011年12月共手术治疗823例胆石症患者，其中60岁以上131例，现报道如下：
1 资料与方法
1.1 一般资料
本组131例患者，男性29例，女性102例。年龄60～83岁，平均66.02岁。病史1 d～21年。胆囊结石伴急慢性胆囊炎118例(其中有右上腹疼痛、压痛及局限性腹膜炎体征者16例，伴发热23例)，化脓性胆囊炎伴胆管炎8例，胆囊息肉样变3例。术前合并心血管疾病74例，合并呼吸系统疾病29例，合并糖尿病34例，合并肝硬化、门脉高压17例，其他合并症11例。
, 百拇医药
1.2 手术方法
131例患者中，急诊手术16例；择期手术114例，其中含姑息性胆囊癌切除术1例；B超引导下经皮经肝胆囊穿刺引流(PTCD)1例。急诊手术和择期手术130例中，开腹胆囊切除术103例；腹腔镜胆囊切除(LC)27例。急诊胆囊切除因颈部结石嵌顿或颈部水肿较重，三胆管无法分辨，行逆行胆囊切除术。择期手术均采用顺逆结合方法行胆囊切除术。腹腔镜胆囊切除(LC)采用三孔法行胆囊切除。B超引导下经皮经肝胆囊穿刺引流(PTCD)是在B超引导下采用腔静脉穿刺导管经皮经肝胆囊穿刺引流。
2结果
全部患者治愈129例，好转2例，无死亡病例。治愈标准为胆囊已完全切除，随访半年以上症状消失。好转2例中，1例行姑息性胆囊癌切除术，术后3个月仍有上腹饱胀不适。另1例在B超引导下经皮经肝胆囊穿刺引流后合并胆囊结石，术后仍有上腹隐痛不适，但症状较前明显减轻。并发切口感染5例，其中脂肪液化3例，切口裂开2例，分别为血糖未控制到9 mmol/L以下1例，低蛋白血症1例，均经二次缝合、对症治疗后治愈；肺部感染8例(6例为急诊)；应激性溃疡1例(为急诊手术)；泌尿系感染6例；急性尿潴留6例(3例为急诊)。, 百拇医药(程铮 虞长春)