老年结石性胆囊炎病人围手术期处理

摘要

目的：探讨老年结石性胆囊炎病人围手术期的处理。方法回顾性分析自2012年5月至2015年5月收治的207例65岁以上老年胆囊结石合并胆囊炎病人的临床资料。结果207例病人中保守治疗11例，手术治疗196例：有175例在发病后72 h 内接受手术治疗，其中直接开腹18例，成功实施腹腔镜手术146例，中转开腹11例，中转率7.0%；有21例在发病72 h 后行手术治疗，其中直接开腹4例，成功完成腹腔镜手术14例，中转开腹3例，中转率17.6%。有17例病人(8.2%)出现不同程度的并发症，除1例因术后突发急性广泛心肌梗死出现严重心律失常而死亡外，余16例病人经治疗后均痊愈。结论迅速完善术前评估、积极处理基础疾病、妥善把握手术时机和着重加强术后监护是老年结石性胆囊炎病人治疗的关键，早期实施腹腔镜胆囊切除术是目前首选的治疗方式。%Objective To explore the perioperative managements of calculous cholecystitis in elderly patients.Methods Retrospective analyses were performed for the clinical data of 207 patients aged over 65 years from May 2012 to May 201 5.Results Conservative (n = 1 1 )and surgical (n =196)treatments were offered.Among 1 75 surgical cases within 72h after onset,there were open chol-ecystectomy (n=1 8),successful laparoscopy (n = 146)and conversion into open surgery (n = 1 1 ). And the conversion rate was 7.0%.And among 21 surgical cases beyond 72 h,there were open chole-cystectomy (n=4),14 cases with successful laparoscopy (n=14)and conversion into open surgery (n=3).And the conversion rate was 1 7.6%.Among 1 7 patients (8.2%)with varying degrees of post-operative complications,only 1 case suffered acute extensively myocardial infarction and died from se-vere arrhythmia.And the remainder was all cured.Conclusions Rapid preoperative evaluations,ac-tively addressing underlying disease,properly grasping surgical timing and strengthening postoperative care are essential for managing calculous cholecystitis in elderly patients.And early laparoscopic chole-cystectomy is preferred.