高龄患者肝外胆道疾病的外科治疗体会(1)
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2011年2月15日
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[摘要] 目的：探讨高龄患者肝外胆道疾病的外科治疗方法及疗效。方法：回顾性分析本院2007年11月~2010年8月收治的82例患肝外胆道疾病的高龄患者的临床资料，60例进行胆囊切除，其中40例行小切口开腹胆囊切除，20例行传统开腹胆囊切除术；22例行胆囊切除术加胆总管切开、T管引流术或胆肠Roux-en-Y吻合术，总结其治疗效果。结果：82例患者中治愈72例，8例转二期手术，死亡2例，其中1例死于严重肺部感染，1例死于肾衰竭，小切口组疗效显著优于传统开腹组，P<0.05。结论：术前充分准备，选择适当术式，是提高高龄患者肝外胆道疾病治愈率的关键。
[关键词] 高龄；肝外胆道疾病；手术治疗
[中图分类号] R657.3 [文献标识码]A[文章编号]1674-4721(2011)02(b)-033-02
Elderly patients with extrahepatic biliary surgical treatment of diseases
TAN Liao
(The First People's Hospital of Loudi City, Hunan Province, Loudi 417009, China)
[Abstract] Objective: To investigate elderly patients with extrahepatic biliary tract disease and efficacy of surgical treatment. Methods: Clinical data of 82 elderly patients of extrahepatic biliary tract disease of our hospital from November 2007 to August 2010 were retrospective analyzed, 60 patients were cholecystectomy, 40 cases in which a small incision cholecystectomy, 20 patients line of traditional open cholecystectomy; 22 patients cholecystectomy plus common bile duct, T tube drainage, or biliary-enteric drainage Roux-en-Y anastomosis to summarize the treatment effects. Results: 82 patients were cured 72 cases, 8 cases of transfer stage operation, 2 cases were died, of which 1 case was died of severe pulmonary infection, 1 patient died of renal failure, small-incision group, efficacy was significantly better than conventional open group, P<0.05. Conclusion: Preoperative fully prepared, select the cut when the surgical, it is the key to improve the cure rate of elderly patients extrahepatic biliary tract disease.
[Key words] Elderly; Extrahepatic biliary tract disease; Surgical treatment
肝外胆道疾病，如急、慢性结石性胆囊炎、胆囊息肉是普外科的常见病、多发病，可引起右上腹部疼痛，闷胀不适以及嗳气等消化不良的症状[1]。目前对于该类疾病的治疗方法以手术为主，多采用开腹胆囊切除或腹腔胆囊切除。本院2007年11月~2010年8月采用手术治疗的82例高龄患者肝外胆道疾病疗效较好，现报道如下：
1 资料与方法
1.1 一般资料
该组患者82例，均为本院收治肝外胆道疾病患者。其中，男性35例，女性47例，年龄62~92岁，平均(71.6±3.2)岁。发病时间多在入院前3 d以内，病程4个月~18年，全部病例术前均行彩超检查，部分患者行CT检查，部分患者见胆总管下段结石及胆总管扩张。有腹部手术史者2例，急性亚急性胆囊炎38例，胆囊颈或胆囊管结石28例，胆囊结石伴胆囊萎缩11例，疑有Mirizzi综合征2例，胆囊壁坏疽1例，合并高血压12例，冠心病7例，慢性支气管炎4例，糖尿病3例，肺气肿2例。
1.2 临床表现
该组患者均有反复右上腹疼痛病史。54例水电酸碱失衡，32例有腹痛、黄疸、寒战发热等Charcot’s三联征，21例合并有休克和精神症状出现Reynold五联征 ......
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