<Original Articles>A Clinical Study of Elderly Patients with Acute Cholecystitis

Abstract

In recent years, an increase in average life expectancy has led to a rapid rise in the number of elderly patients undergoing surgeηr for acute cholecystitis. We studied the clinical characteristics of elderly patients (aged 7S years of more） undergoing surgery for acute cholecystitis, as compared with those of non-elderly patients (aged less than 75 years) undergoing similar procedures. Twenty-four of the patients were elderly, and 44 were non-elderly. [Results J Echography and abdominal computed tomography (CT) revealed no characteristic findings specific to elderly patients, but a smaller proportion of elderly patients showed a three-layered structure of the gallbladder wall. The leukocyte count on admission was significantly lower in elderly patients than in non-elderly patients. As for therapy, a significantly higher proportion of elderly patients underwent percutaneous transhepatic gallbladder drainage (PTG BD) + cholecystectomy+ choledochotomy/choledocholithotomy, as compared with non-elderly patients. In contrast, cholecystectomy alone was performed more frequently in non-elderly patients than in elderly patients. The main postoperative complications were psychic symptoms and respiratory tract infections. The postoperative hospital stay was significantly longer for elderly patients, in part because they requested to remain in the hospital until they were able to perform activities of daily living.

[要旨]近年, 平均寿命の延長に伴い, 高齢者の急性胆嚢炎手術例も急増してきた. 高齢（75歳以上）と非高齢者（75歳未満）を比較し, 高齢者の急性胆嚢炎手術症例について臨床的特徴を検討した. 1989年4月より6年聞に急性胆嚢炎として手術した症例は68例であった. 高齢者は24例で, 非高齢者は44例であった. [成績] echo像, 腹部CT検査所見では, 特徴的な所見は得られなかったが, 壁の三層構造を示す症例が少なかった. 入院時の白血球数は非高齢者より有意に少なかった. 治療法では胆摘のみの症例よりもPTGBD＋胆摘＋総胆管切開術の症例が有意に多かった. 術後合併症では精神症状や呼吸器感染が多く認められた. また, 壊疽性胆嚢炎に胆嚢穿孔と胆汁性腹膜炎併発し, 術後多臓器不全で死亡した症例以外は前例救命しえた. 在院日数は日常生活が出来るまで在院させてほしいとの希望もあり有意に長かった.