The Diagnosis And Treatment Of Senile Acute Cholangitis

Background: With the change of population composition in our country, the aging population was increased,and the morbility of senile acute cholangitis was obviously increasing. The function of most organs in elder patients is in retrogressive condition, and is not sensitive to the stimulus of pain. Besides, elder patients always, suffer from many concurrent diseases such as heart disease, hypertension and diabetes et al.. Clinical manifestations, signs and laboratory findings are not obvious in patients of senile acute cholangitis at the early stage. So it is not easy to diagnose at the early stage and the delayed diagnosis and treatment would take place. The patient's condition would quickly deteriorate into acute obstructive suppurative cholangitis(AOSC) or multiple organ failure (MOF) and threaten one's life.Objective: To study the methods of the diagnosis and treatment of senile acute cholangitis.Methods: Two hundred and sixty-four patients with acute cholansgistis(20-92) had been selected from our hospital during March , 2008 to December , 2010. Amoung then there were 152 cases of senile acute cholangitis patients(≥60 years),80 male cases(30.3%), 72 female cases(27.3%), and the average age was 72.68±8.30. A retrospective diagnosis and treatments in patients of senile acute cholangitis were made.Results: Comparing the senile patients with acute cholangitis the mobility of concurrent desease(73.3%) was more than younger patients with acute cholangitis (X~2=11.7,p=0.046). There were 79 case(51.9%)suffer from abdominal pain in admition in senile acute cholangitis,which was less than 92 cases(81.2%)in younger acute cholangitis patients (X~2=3.526,p=0.027). The high fever or chills was in 98 cases(64.4%) in senile patients and less than in 93 cases (83.0%) in younger patients(X~2=3.172,p=0.037). Appearing shock and neurological symptoms were in 14 senile cases (9.2%) and in 3cases(2.6%)in younger patients(P<0.05). Signs of abdominal tenderness and rebound tenderness and rigidity were in 59 cases senile patients (38.8%) , and was in 21cases(18.7%)in younger patients( X~2=0.429, P=0.043). The abnormality lab findings when admitted to hospital such as white blood cells count, percentage of neutrophils, electrolyte imbalances in the senile was more than in the younger (P<0.05).The postoperative complications of surgery or interventional therapy in the senile was 19 (12.5%)more than in younger 1(0.8%)(P<0.05).Average hospitalization time:in the senile was 15.8±4.7days more than in the younger 12.9±3.6days (t=4.367,P=0.035).Conclusion: Patients with senile acute cholangitis always concurrent with many other diseases.The patients have poor tolerance and dull response to stimulate. Clinical manifestations, signs and laboratory findings are not obvious in elderly with acute cholangitis at the early stage. So it is not easy to diagnosis at the early stage. Front-line therapy of elderly acute cholansgistis wouls include effective antibiotics, adjustment of electrolyte, and fluid balance, prevention of shock and supportive treatment et al.. Endoscopic therapy is superior to operation and laparoscopy, with advantages such as high achievement ratio, less complications, short time procedure , short hospitalization period , simple anesthesia. Percutaneous transhepatic cholangiography drainage(PTCD) can relief the obstruction in emergency , it can win the time for following treatment. One of the shortage is problems cannot be settled at one time, and need followed treatment. Endoscopic therapy has some specific indication. Laparoscopy and opening surgery for biliary tract decompression are additions for Endoscopic therapy.