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289例老年胆道疾病患者的治疗经验

Therapeutic experience of 289 elderly patients with biliary diseases.

作者信息

Zhang Zong-Ming, Liu Zhuo, Liu Li-Min, Zhang Chong, Yu Hong-Wei, Wan Bai-Jiang, Deng Hai, Zhu Ming-Wen, Liu Zi-Xu, Wei Wen-Ping, Song Meng-Meng, Zhao Yue

机构信息

Zong-Ming Zhang, Zhuo Liu, Li-Min Liu, Chong Zhang, Hong-Wei Yu, Bai-Jiang Wan, Hai Deng, Ming-Wen Zhu, Zi-Xu Liu, Wen-Ping Wei, Meng-Meng Song, Yue Zhao, Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China.

出版信息

World J Gastroenterol. 2017 Apr 7;23(13):2424-2434. doi: 10.3748/wjg.v23.i13.2424.

Abstract

AIM

To present clinical characteristics, diagnosis and treatment strategies in elderly patients with biliary diseases.

METHODS

A total of 289 elderly patients with biliary diseases were enrolled in this study. The clinical data relating to these patients were collected in our hospital from June 2013 to May 2016. Patient age, disease type, coexisting diseases, laboratory examinations, surgical methods, postoperative complications and therapeutic outcomes were analyzed.

RESULTS

The average age of the 289 patients with biliary diseases was 73.9 ± 8.5 years (range, 60-102 years). One hundred and thirty-one patients (45.3%) had one of 10 different biliary diseases, such as gallbladder stones, common bile duct stones, and cholangiocarcinoma. The remaining patients (54.7%) had two types of biliary diseases. One hundred and seventy-nine patients underwent 9 different surgical treatments, including pancreaticoduodenectomy, radical resection of hilar cholangiocarcinoma and laparoscopic cholecystectomy. Ten postoperative complications occurred with an incidence of 39.3% (68/173), and hypopotassemia showed the highest incidence (33.8%, 23/68). One hundred and sixteen patients underwent non-surgical treatments, including anti-infection, symptomatic and supportive treatments. The cure rate was 97.1% (168/173) in the surgical group and 87.1% (101/116) in the non-surgical group. The difference between these two groups was statistically significant ( = 17.227, < 0.05).

CONCLUSION

Active treatment of coexisting diseases, management of indications and surgical opportunities, appropriate selection of surgical procedures, improvements in perioperative therapy, and timely management of postoperative complications are key factors in enhancing therapeutic efficacy in elderly patients with biliary diseases.

摘要

目的

阐述老年胆道疾病患者的临床特征、诊断及治疗策略。

方法

本研究共纳入289例老年胆道疾病患者。2013年6月至2016年5月期间在我院收集这些患者的临床资料。分析患者年龄、疾病类型、并存疾病、实验室检查、手术方式、术后并发症及治疗效果。

结果

289例胆道疾病患者的平均年龄为73.9±8.5岁(范围60 - 102岁)。131例(45.3%)患者患有10种不同胆道疾病中的一种,如胆囊结石、胆总管结石及胆管癌。其余患者(54.7%)患有两种胆道疾病。179例患者接受了9种不同手术治疗,包括胰十二指肠切除术、肝门胆管癌根治切除术及腹腔镜胆囊切除术。发生10例术后并发症,发生率为39.3%(68/173),低钾血症发生率最高(33.8%,23/68)。116例患者接受非手术治疗,包括抗感染、对症及支持治疗。手术组治愈率为97.1%(168/173),非手术组为87.1%(101/116)。两组差异有统计学意义( = 17.227, < 0.05)。

结论

积极治疗并存疾病、把握手术指征及时机、合理选择手术方式、改善围手术期治疗及及时处理术后并发症是提高老年胆道疾病患者治疗效果的关键因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d36/5385409/e792aad6a9d6/WJG-23-2424-g001.jpg

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