Miroshnikov B I, Svetlovidov V V, Balabushkin I A
Khirurgiia (Mosk). 1994 Jan(1):23-5.
The severity of morphological changes in the gallbladder and complicated course of the disease are the principal factors causing an unfavorable effect on the results of treatment of acute cholecystitis in patients over 80 years of age. Early surgical intervention is the basis of the therapeutical tactics. The choice of the operation is determined by the organism's functional condition which is evaluated according to its capacity for work. In patients with a compensated functional condition the volume of the surgical intervention does not differ from that generally accepted. In patients with a decompensated condition preference should be given to conservative surgery (percutaneous transhepatic puncture, decompression and cleansing of the gallbladder or microcholecystecstomy under echographic control) or treatment applied in stages, alternating various types of surgical manipulations. Postoperative mortality was 14% per 142 operated-on patients.
胆囊形态学改变的严重程度及疾病的复杂病程是对80岁以上急性胆囊炎患者治疗效果产生不利影响的主要因素。早期手术干预是治疗策略的基础。手术方式的选择取决于机体的功能状况，而机体功能状况是根据其工作能力来评估的。对于功能状况代偿的患者，手术干预的范围与一般公认的无异。对于功能失代偿的患者，应优先选择保守手术（经皮肝穿刺、胆囊减压及冲洗或在超声引导下进行微小胆囊切除术）或分阶段治疗，交替进行各种手术操作。142例接受手术治疗的患者术后死亡率为14%。
