Morrow D J, Thompson J, Wilson S E
Arch Surg. 1978 Oct;113(10):1149-52. doi: 10.1001/archsurg.1978.01370220035006.
A retrospective review of 88 male patients older than 60 years of age with billiary tract disease showed a mortality of 6.8%. More than 40% of the patients (39 of 88) had acute cholecystitis. Medical therapy failed for almost all of the patients (38 of 39) with acute inflammatory disease and they then required an operation during their initial hospitalization. In this acute disease group, 21% had empyema of the gallbladder, 18% had gangrenous cholecystitis or free perforation of the gallbladder, and 15% had subphrenic or liver abscesses. Escherichia coli and Klebsiella were obtained from 78% of the bile cultures, and obligate anaerobes were present in 25% of them. A delay in diagnosis and operation occurred in 33% of the patients with acute disease. Factors responsible for this delay included a deceptively benign clinical presentation and the requirement for prolonged resuscitation. Since response to conservative measures is unlikely in the elderly patient with acute cholecystitis, optimal management consists of resuscitation and prompt operation for control of infection.
对88例60岁以上患有胆道疾病的男性患者进行的回顾性研究显示，死亡率为6.8%。超过40%的患者（88例中的39例）患有急性胆囊炎。几乎所有患有急性炎症性疾病的患者（39例中的38例）内科治疗均失败，随后在首次住院期间需要进行手术。在这个急性疾病组中，21%患有胆囊积脓，18%患有坏疽性胆囊炎或胆囊游离穿孔，15%患有膈下或肝脓肿。78%的胆汁培养物中分离出大肠杆菌和克雷伯菌，其中25%存在专性厌氧菌。33%的急性疾病患者诊断和手术出现延迟。导致这种延迟的因素包括看似良性的临床表现以及需要长时间复苏。由于老年急性胆囊炎患者对保守措施反应不佳，最佳治疗方法是复苏并迅速手术以控制感染。
