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目的:探讨老年急性重症胆管炎的临床特点、治疗对策及预后。方法:对135例老年重症胆管炎患者的临床资料进行回顾性分析,总结其临床特点、治疗方式和预后情况。结果:外科手术共71例,死亡6例(8.5%),其中急诊手术36例,死亡3例(8.3%),经>24 h保守治疗后择期手术35例,死亡3例(8.6%);十二指肠镜治疗39例,死亡1例(2.6%);保守治疗25例,死亡8例(32%)。病死率11.1%,死亡原因:败血症、中毒性休克8例,消化道出血3例,多器官功能衰竭4例。结论:早期解除梗阻,充分引流胆道是治疗老年急性重症胆管炎的关键;贻误手术时机、高龄及严重并发症是死亡主要原因;急诊内镜治疗急性重症胆管炎操作简便,安全有效,尤其适合老年患者。
Objective: To investigate the clinical features, treatment strategies and prognosis of elderly acute cholangitis. Methods: The clinical data of 135 elderly patients with severe cholangitis were retrospectively analyzed. The clinical features, treatment methods and prognosis were summarized. Results: A total of 71 surgical patients were killed in 6 cases (8.5%), including 36 cases of emergency operation and 3 cases of death (8.3%). After conservative treatment for 24 hours, 35 cases were elective surgery and 3 cases died (8.6%). 39 cases were treated by duodenoscopy and 1 case died of death (2.6%). Conservative treatment was performed in 25 cases and death occurred in 8 cases (32%). The case fatality rate was 11.1%. The cause of death was sepsis, poisoning shock in 8 cases, gastrointestinal bleeding in 3 cases and multiple organ failure in 4 cases. Conclusion: The early obstruction, the full drainage of the bile duct is the key to the treatment of elderly patients with acute cholangitis; delaying the operation timing, advanced age and serious complications are the main causes of death; emergency endoscopic treatment of acute cholangitis is easy, safe and effective, especially for the elderly patient.