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目的 :探讨老年人急性非结石性胆囊炎 (Acute acalculous cholecystitis,AAC)临床特点与最佳手术时机。方法 :通过设立严格的病例对照 ,比较了 5 2例老年人 AAC和急性结石性胆囊炎 (Acute calculouscholecystitis,ACC)的并存病、胆囊病理改变及术后结果 ;并对不同手术时机的老年人 AAC胆囊病变与术后结果进行比较。结果 :与老年人 ACC相比 ,AAC患者以心血管疾病为主的并存病明显增多 (P<0 .0 0 1) ;胆囊化脓、坏疽与穿孔率明显增高 (P值 <0 .0 1,<0 .0 0 1,<0 .0 5 ) ;术后并发症发生率明显上升 (P<0 .0 0 1)。病死率无显著差异 (P>0 .0 5 )。发病 48小时以上手术的 AAC胆囊坏疽与穿孔率及术后并发症发生率与病死率均较 48小时内手术者明显增高 (P值分别 <0 .0 0 1,<0 .0 0 1,<0 .0 5 )。结论 :老年人 AAC并存病多、胆囊病变重、术后并发症发生率高 ;宜在症状出现 48小时内手术治疗。
Objective: To investigate the clinical features and the optimal operation timing of Acute acalculous cholecystitis (AAC) in the elderly. Methods: By setting up a strict case control, the complication and pathological changes of AAC and Acute calculouscholecystitis (ACC) in 52 elderly patients were compared. The AAC Gallbladder disease and postoperative results were compared. Results: The prevalence of cardiovascular disease in patients with AAC was significantly higher than that in the elderly (P <0.01). The rates of pus, gangrene and perforation in gallbladder were significantly higher (P <0.01, <0 0 01, <0 0 05). The incidence of postoperative complications increased significantly (P 0 01). No significant difference in mortality (P> 0.05). AAC gallbladder gangrene and perforation rates and postoperative complications and mortality rates were significantly higher than those within 48 hours (P <0. 01, 0 .0 5). Conclusion: AAC is more common in the elderly, gallbladder disease is more serious and the incidence of postoperative complications is high. It is advisable to treat the patients within 48 hours after the symptoms appear.