老年急性胰腺炎的诊断治疗
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张辉 E-mail:exonsu@hotmail.com

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Diagnosis and treatment of acute pancreatitis in elderly patients
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    摘要:

    目的:探讨老年急性胰腺炎(AP)的诊断和治疗。
    方法:回顾性分析5年间住院治疗的老年急性胰腺炎患者254例(老年组,年龄≥60岁)的临床资料。并与同期住院的非老年急性胰腺炎患者(对照组,年龄<60岁)258例进行比较。
    结果:老年组,男∶女=1.00∶1.27。胆源性因素占发病原因的70.9%。其中轻症(MAP)218例,治愈216例,死亡2例(0.92%);重症(SAP)36例,治愈23例,死亡13例(36.11%)。病死率与年龄、轻重程度有关(P<0.01)。对照组,男∶女=1.00∶1.00。胆源性发病因素占46.1%。MAP 216例,均治愈,SAP 22例治愈19例,死亡3例(13.6%)。老年组血淀粉酶(1 054.97±775.60)U/L及总胆红素(40.97±37.11)μmol/L升高大于对照组,差异有统计学意义(P<0.05)。全组CT检查的阳性符合率(68.9%)明显高于B超(22.8%)(P<0.01)。老年组行手术治疗65例,ERCP 46例占70.8%,常规手术治疗26例,对照组手术治疗51例,其中ERCP 28例,常规手术治疗23例。老年组有35例发生不同种类并发症(13.8%)多于对照组的20例(78%)(P<0.05)。
    结论:老年AP胆源性因素居多。血淀粉酶及总胆红素升高明显;并发症多;病死率高。CT是AP首选的辅助检查。治疗上以综合治疗为主。ERCP对于胆道梗阻、感染引起的老年急性胰腺炎患者较为适用。老年重症急性胰腺炎病死率高,且随年龄的增加而上升。

    Abstract:

    Objective:To discuss the diagnosis and treatment of acute pancreatitis in elderly patients.
    Methods:The data of 254 consecutive elderly patients with acute pancreatitis treated in our hospital in recent 5 years were analysed, retrospectively, and compared with another 258 non-elderly patients with acute pancreatitis (control group).
    Results:Among the elderly patients(≥60 years old) with acute pancreatitis, 112 of them were male and 142 were female. In elderly group, 218 cases had mild acute pancreatitis (MAP), 2 of whom died; and 36 cases had severe acute pancreatitis (SAP), 13 of whom died. There was a positive relationship between mortality and age (P<0.01).The rate of the acute pancreatitis caused by biliary diseases was 70.9%. Compared to control group, in the elderly group the levels of blood amylase (1 054.97±775.60)U/L and serum total bilirubin (40.97±37.11) μmol/L were much higher (P<0.05); and the diagnostic rate of CT(68.9%) was obviously higher than that of ultrasound(22.8%)(P<0.01). Surgical treatment was applied to 65 elderly patients, and 46 of them underwent endoscopic treatment.  In elderly group, 35 patients(13.8%) suffered various complications; but only 20 patients (78%) had complications in control group(P<0.05). 
    Conclusions:The cause of acute pancreatitis  in elderly patients is usually related to biliary factors. Marked elevation of blood amylase and serum total bilirubin is significant in these patients, and they have more complications and a high mortality. CT should be the first method used for the diagnosis of acute pancreatitis in the elderly, and combined therapeutic measures should be employed.  ERCP can be indicated for the elderly patients with acute pancreatitis caused by  obstruction and infection of bile duct. Mortality of acute pancreatitis in the elderly is high and it increases with increasing age of the patient.

     

     

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苏明琪| 张辉| 周嘉.老年急性胰腺炎的诊断治疗[J].中国普通外科杂志,2011,20(3):253-256.

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  • 收稿日期:2010-07-13
  • 最后修改日期:2010-09-22
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  • 在线发布日期: 2011-03-15
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