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目的探讨老年重症急性非结石性胆囊炎(acute acalculous cholecystitis,AAC)患者手术时机及方式的选择。方法将62例经手术治疗的老年重症AAC患者分为2组,对照组33,急诊行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC),实验组29例,急诊行经皮胆囊穿刺造瘘术(percutaneous cholecystostomy,PC),6~8周后行LC。对比两组患者术中及术后状况以及术后并发症等方面。结果两组的手术时间、术中出血量、死亡率、中转开腹率以及胆囊坏疽数比较差异无统计学意义(P>0.05)。实验组ICU时间、住院天数以及术后并发症比较,明显低于对照组,差异有统计学意义(P<0.05)。结论老年重症AAC患者治疗过程中,急诊行PC穿刺引流联合6~8周择期LC相比急诊LC在ICU时间、住院时间以及术后并发症方面具有显著优势。
Objective To investigate the timing and method of operation in elderly patients with acute acalculous cholecystitis (AAC). Methods A total of 62 elderly patients with severe acute respiratory syndrome (AAC) were divided into two groups. The control group consisted of 33 patients who underwent laparoscopic cholecystectomy (LC) in the emergency department. Twenty - nine patients in the experimental group underwent emergency percutaneous cholecystectomy (percutaneous cholecystostomy, PC), 6 to 8 weeks after LC. Comparing two groups of patients during surgery and postoperative conditions and postoperative complications. Results The operation time, intraoperative blood loss, mortality, transfer to laparotomy, and gallbladder gangrene in the two groups had no significant difference (P> 0.05). The ICU time, length of hospital stay, and postoperative complications in the experimental group were significantly lower than those in the control group (P <0.05). Conclusions In the treatment of elderly patients with severe AAC, PC puncture and drainage in combination with 6 ~ 8 weeks of emergency LC have significant advantages in terms of ICU time, hospitalization time and postoperative complications compared with emergency LC.