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目的探讨老年人急性非结石性胆囊炎(acute acalculous cholecystitis,AAC)的最佳手术时机。方法回顾性分析20年来45例老年人 AAC 不同手术时机的的胆囊理改变及手术后并发症和死亡情况。结果老年人 AAC 约60%合并有糖尿病、心血管疾病及慢性阻塞性肺疾患。从 AAC 症状出现至实施手术的平均间隔时间为46.8±2.5小时,与同期老年人急性结石性胆囊炎(acute calculous cholecystitis,ACC)相比,老年人 AAC 的胆囊坏疽穿孔率明显增高(P<0.01)。老年人 AAC 症状出现48小时内手术者较超过48小时手术者术后并发症和病死率明显减少(P<0.01)。结论老年人 AAC 宜在症状出现48小时内实施手术治疗。
Objective To explore the best timing of surgery in the elderly with acute acalculous cholecystitis (AAC). Methods A retrospective analysis of 45 elderly patients with AAC at different timing of gallbladder surgery and postoperative complications and death. Results About 60% of AACs in the elderly were associated with diabetes, cardiovascular disease and chronic obstructive pulmonary disease. The mean time between the appearance of AAC symptoms and the operation was 46.8 ± 2.5 hours, and the perforation rate of gallbladder gangrene was significantly higher in aged AAC patients (P <0.01) than that in elderly patients with acute calculous cholecystitis (ACC) ). Postoperative complications and mortality were significantly reduced (P <0.01) for the elderly with AAC symptoms within 48 hours of surgery for more than 48 hours. Conclusion AAC should be operated in the elderly within 48 hours after the onset of symptoms.