van Assen S, Nagengast F M, van Goor H, Cools B M
Afd. Algemene Interne Geneeskunde, Universitair Medisch Centrum St Radboud, Postbus 9101, 6500 HB Nijmegen.
Ned Tijdschr Geneeskd. 2003 Jan 25;147(4):146-50.
Gallstone diseases (asymptomatic, symptomatic and complicated) are frequently seen in the elderly; the prevalence increases proportionally with age. At higher ages (> 60 years) the presentation of symptomatic or complicated gallstone disease is frequently atypical. Complicated gallstone disease (especially cholecystitis and cholangitis) in the elderly is associated with high morbidity and mortality rates. The introduction of laparoscopic cholecystectomy has decreased the morbidity and mortality rates of symptomatic and complicated gallstone disease in the elderly; for elective procedures in particular, the risks hardly differ from those for younger patients. Percutaneous cholecystostomy is an effective and safe alternative for (laparoscopic) cholecystectomy in high-risk patients with an acute cholecystitis. Endoscopic retrograde cholangiopancreaticography (ERCP) with sphincterotomy is also the treatment of choice for common bile duct stones in the elderly. After removal of common bile duct stones (whether or not accompanied by cholangitis or pancreatitis) a laparoscopic cholecystectomy should be performed, unless contraindications are present.
胆结石疾病（无症状、有症状和复杂型）在老年人中很常见；患病率随年龄成比例增加。在较高年龄（>60岁）时，有症状或复杂型胆结石疾病的表现通常不典型。老年人的复杂型胆结石疾病（尤其是胆囊炎和胆管炎）与高发病率和死亡率相关。腹腔镜胆囊切除术的引入降低了老年人有症状和复杂型胆结石疾病的发病率和死亡率；特别是对于择期手术，其风险与年轻患者的风险几乎没有差异。经皮胆囊造瘘术是急性胆囊炎高危患者（腹腔镜）胆囊切除术的一种有效且安全的替代方法。内镜逆行胰胆管造影术（ERCP）及括约肌切开术也是老年人胆总管结石的首选治疗方法。在去除胆总管结石后（无论是否伴有胆管炎或胰腺炎），除非存在禁忌症，均应进行腹腔镜胆囊切除术。
