Smith N, Max M H
South Med J. 1987 Apr;80(4):472-4. doi: 10.1097/00007611-198704000-00016.
We reviewed the records of 101 patients over the age of 60 who had exploration and cholecystectomy in 1982 at Norfolk General Hospital. There were 52 elective and 49 emergency cases. Women comprised 57.4% of the patients, and almost 50% of the patients were over the age of 70. Forty-nine percent of the cases were emergencies. All but two of the patients had cholecystectomy. The average hospital stay was 12 days for the elective group and 19 days for the urgent group. Complications extended the average hospital stay to 23 days. Although complications developed in 35 patients, only 14 had major complications that were life-threatening and/or extended the hospital stay. Of these, four were in elective cases (7%) and the remainder (21%) were in the urgent group. A major complication more than doubled the average hospital stay to 29 days. There were three deaths (3% of the entire group), all in patients who had emergency exploration, and all in patients over age 70. We advocate earlier elective cholecystectomy for patients with symptomatic cholelithiasis--before patients reach an older age, when associated systemic diseases increase their overall risk should emergency operation be necessary.
我们回顾了1982年在诺福克总医院接受探查及胆囊切除术的101例60岁以上患者的记录。其中有52例择期手术病例和49例急诊病例。女性占患者总数的57.4%，近50%的患者年龄超过70岁。49%的病例为急诊。除两名患者外，所有患者均接受了胆囊切除术。择期手术组的平均住院时间为12天，急诊组为19天。并发症使平均住院时间延长至23天。虽然35例患者出现了并发症，但只有14例出现了危及生命和/或延长住院时间的严重并发症。其中，4例发生在择期手术病例中（7%），其余（21%）发生在急诊组。严重并发症使平均住院时间增加了一倍多，达到29天。有3例死亡（占整个组的3%），均发生在接受急诊探查的患者中，且均为70岁以上的患者。我们主张对有症状的胆石症患者尽早进行择期胆囊切除术——在患者年龄增大之前，因为一旦需要进行急诊手术，相关的全身性疾病会增加他们的总体风险。
