CAJ | 학술논문

目的探讨80岁以上高龄胆囊结石胆囊炎的诊治经验.方法回顾性分析46例高龄胆囊结石胆囊炎的临床资料及治疗效果,比较不同治疗方式的并发症发生情况及其相关因素.结果全组共46例患者,中位年龄82.5岁(80～ 98岁),43例合并其他基础疾病;保守治疗16例(34.8％),择期手术17例(37.0％),急诊手术13例(28.3％),总并发症发生率为47.7％ (21/44),三种治疗方式的并发症发生率依次为64.3％ (9/14)、11.8％ (2/17)、76.9％(10/13),差异有统计学意义(x2=14.793,P=0.001);Logistic回归分析显示治疗方式是并发症发生的独立危险因素(Wald=8.571,P=0.014),择期手术相较于另外两种治疗方式并发症发生率最低(P =0.007,OR =0.025).结论 80岁以上高龄患者胆囊结石、胆囊炎临床表现相对隐蔽,常与病情变化不一致.择期手术治疗可以减少并发症发生,正确把握手术时机确为提高疗效、减少并发症发生的关键.
목적 탐토80세이상고령담낭결석담낭염적진치경험.방법 회고성분석46례고령담낭결석담낭염적림상자료급치료효과,비교불동치료방식적병발증발생정황급기상관인소.결과 전조공46례환자,중위년령82.5세(80～ 98세),43례합병기타기출질병;보수치료16례(34.8％),택기수술17례(37.0％),급진수술13례(28.3％),총병발증발생솔위47.7％ (21/44),삼충치료방식적병발증발생솔의차위64.3％ (9/14)、11.8％ (2/17)、76.9％(10/13),차이유통계학의의(x2=14.793,P=0.001);Logistic회귀분석현시치료방식시병발증발생적독립위험인소(Wald=8.571,P=0.014),택기수술상교우령외량충치료방식병발증발생솔최저(P =0.007,OR =0.025).결론 80세이상고령환자담낭결석、담낭염림상표현상대은폐,상여병정변화불일치.택기수술치료가이감소병발증발생,정학파악수술시궤학위제고료효、감소병발증발생적관건.
Objective To sum up experiences in diagnosing and treating cholecystolithiasis and cholecystitis of patients 80 years of age and older.Method A retrospective study was made on the clinical data of aged at 80 and older patients with gall stone and cholecystitis treated at our surgical unit.Data included age and gender,presentation,comorbid illness,treatment methods,operative time,length of hospital stay and complications.Results Forty-six consecutive patients aged at 80 or older who had gallbladder stone and cholecystitis were studied.The median age was 82.5 (80 to 98 years) ; 43 patients were with comorbid diseases.Patients were divided into three groups based on the therapy methods:Group 1 (16 patients,34.8％) were treated conservatively; Group 2 (17 patients,37％) received elective surgery;Group 3(13 patients,28.3％) received emergency surgery.The complication rate was 47.7％ (21/44)under evaluable basis,whereas the complication rate for each group were 64.3％ (9/14),11.8％ (2/17),76.9％ (10/13) respectively (x2 =14.793,P =0.001).Logistic analysis indicated that the type of treatment selected was a sole factor for complication rate (P =0.014).Our study showed that elective surgery had a lower complication rate than conservative treatment and emergency surgery (P =0.007,OR =0.025).Conclusions Cholecystolithiasis,cholecystitis in very old patients are relatively of less clinical manifestations compared to younger patients.Elective surgery can reduce disease-related complications.