Marggraf W
Z Gerontol. 1982 May-Jun;15(3):205-9.
The surgery of the gall bladder by gallstones, bile duct and alterations of the duodenal papilla are conducted with an increase of lethality. This increased lethality is caused by accompanying ill effects, especially chronical pancreatitis, cholangitis, disturbances of the liver. The indications to operate old patients are occlusions of duodenal papilla relapsing colics with or less occlusing icterus, emphysema of gall bladder or perforation. A careful narcosis is necessary by disease of circulation, diabetes, bronchitis and emphysema of the lung. Simple cholestectomies in old patients have a mortality of 0-1%. Interventions on bile ducts, transduodenal papillotomia, choledochoduodenotomy have an mortality of 4-8%. The intraoperative cholangiography is always necessary. Operations on bile duct are finished by inserting a T-drain. The distal portion of the T-drain are not emissed through the duodenal papilla, because a pancreatitis can be released. The principal postoperative complication is the pancreatitis, consumption coagulopathy, bronchopneumonia, cholangitis with intermitting fever and injuries of the liver parenchym. The persisting pancreatitis can be treated with infusions.
因胆结石、胆管及十二指肠乳头病变而进行的胆囊手术，其致死率有所增加。这种致死率的增加是由伴随的不良影响导致的，尤其是慢性胰腺炎、胆管炎、肝脏功能紊乱。老年患者的手术指征为十二指肠乳头梗阻、伴有或不伴有梗阻性黄疸的复发性绞痛、胆囊气肿或穿孔。对于患有循环系统疾病、糖尿病、支气管炎和肺气肿的患者，需要谨慎麻醉。老年患者单纯胆囊切除术的死亡率为0 - 1%。胆管手术、经十二指肠乳头切开术、胆总管十二指肠吻合术的死亡率为4 - 8%。术中胆管造影总是必要的。胆管手术通过插入T形引流管完成。T形引流管的远端不通过十二指肠乳头引出，因为这可能引发胰腺炎。主要的术后并发症是胰腺炎、消耗性凝血病、支气管肺炎、伴有间歇性发热的胆管炎以及肝实质损伤。持续性胰腺炎可用输液治疗。
