Irvin T T, Arnstein P M
Department of Surgery, Royal Devon and Exeter Hospital (Wonford), UK.
Br J Surg. 1988 Dec;75(12):1163-5. doi: 10.1002/bjs.1800751206.
In a study of 544 patients with symptomatic gallstones 158 subjects were aged greater than 70 years. Elderly patients had a significantly higher incidence of emergency presentation, jaundice, cholangitis, ductal stones, biliary drainage procedures, and acute complications requiring urgent or emergency surgery (P less than 0.001); they had more than twice the incidence of postoperative complications in comparison with patients aged less than 70 years. There was an increased perioperative mortality in the elderly (1.3 per cent after cholecystectomy and 2.9 per cent after bile duct exploration, P = 0.039). Conservative treatment in 11 per cent of elderly patients resulted in no mortality due to gallstones, but 3 of 17 patients had recurrent biliary symptoms. It was estimated that 38 per cent of the bile duct explorations in the elderly might have been avoided by referral for endoscopic sphincterotomy, but surgical treatment of gallstones in the district general hospital is relatively safe and specialist referral should be considered only in the relatively small number of 'high risk' cases.
在一项针对544例有症状胆结石患者的研究中，158名受试者年龄超过70岁。老年患者急诊就诊、黄疸、胆管炎、胆管结石、胆道引流手术以及需要紧急或急诊手术的急性并发症的发生率显著更高（P<0.001）；与年龄小于70岁的患者相比，他们术后并发症的发生率高出两倍多。老年患者围手术期死亡率增加（胆囊切除术后为1.3%，胆管探查术后为2.9%，P=0.039）。11%的老年患者采用保守治疗，未因胆结石导致死亡，但17例患者中有3例出现复发性胆道症状。据估计，通过转诊进行内镜括约肌切开术，老年患者中38%的胆管探查术可能可以避免，但在地区综合医院进行胆结石手术治疗相对安全，仅在相对少数的“高危”病例中应考虑转诊至专科治疗。
