| Background Acute cholangitis is due to intrahepatic bile duct system obstruction caused by secondary bacterial infection which is caused by acute inflammatory lesions,which are most commonly found in patients with common bile duct stones.When the common bile duct stones cannot be removed in time,neither effectively control for the bile duct obstruction caused by infection.It could develop into acute obstructive suppurative cholangitis,which may cause SIRS,sepsis,disseminated intravascular coagulation and even multiple organ disorder syndrome.With the aging population in China,the incidence of high age patients(above 80 years old)with calculous cholangitis was increased year by year.Due to its poor constitution,coexisting basic diseases,acute onset and rapid progress,and its own clinical features,the diagnosis and treatment could be usually delayed.Therefore,the classification of the aged patients with cholangitis,surgery time point,surgical methods and treatment strategies could become the key factors in the prognosis.Obj ective:To investigate the clinical characteristics,classification diagnosis,surgery time point,surgical methods of aged cholelithiasis cholangitis,and the effect of integrated traditional and western medical treatment.Methods:The clinical data were collected from 100 patients with aged cholangitis(?80 years old)who were admitted to our hospital from January 2014 to December 2016.Patients were divided into mild(grade I),moderate(grade II)and severe(grade III)by cholangitis severity classification criteria.The general information of patients with advanced age cholelithiasis cholangitis,the choice of surgical time and surgical methods,were analyzed and the clinical characteristics,classification diagnosis and the effect of integrated traditional and western medical treatment were explored.Results:?Among the 100 cases of elderly patients with cholelithiasis cholangitis,there were 49 males and 51 females with an average age of 83.7±0.7years.There are 70 patients(70%)have complication,besides 27 cases(27%)had more that two kinds of complication.Twanty one cases(21%)had fever(T>38?),twanty four cases(24%)had jaundice,Sixty six cases(66%)had severe abdominal pain,seven cases(7%)had typical Charcot sign.There were also 20 cases in which the WBC was above 10×109/L.? There were 23 patients(23%)with mild grade(grade ?),Sixty six cases with moderate grade(66%)and 11 cases with severe grade(grade ?).There was no significant difference in sex,age,and concomitant disease.? There were no significant differences in the number of total hospitalization days and postoperative hospitalization days in the three groups.In total 23 cases of mild cholangitis,there was 2 cases of complications and the incidence was 9%.These two cases were all LC+LCBDE postoperative pulmonary infection.In total 66 cases of moderate cholangitis,there were 13 cases of complications and the incidence was 20%.In total 11 cases of severe cholangitis,there were 6 cases of complications and the incidence was 55%.The incidence of postoperative complications was significantly different between mild&moderate grade and severe grade(P<0.05).? Among 8 in 23 patients with mild cholangitis(35%),twanty one in 66 patients with moderate cholangitis(32%)and 5 in 11patients with severe cholangitis(45%)had been offered the traditional Chinese medicine Qing Re Li Dan(QRLD).The treatment rate was no significant difference.The aged cholelithiasis cholangitis patients were divided into the two groups:traditional Chinese medicine group and control group.Finally,there was no significant difference in sex,age,concomitant disease,severity grade,postoperative hospitalization stay and total hospitalization stay between the two groups.The time of bilirubin and liver function recovery in patients who treated with the traditional medicine QRLD was significantly shorter than the control group(P<0.05).Conclusion:?Elderly patients have poor physical conditions who often combined with basic diseases in the circulation,endocrine,nerve and respiratory system;?In elderly patients with acute cholelithiasis cholangitis there was atypical clinical symptoms and signs.Also,their clinical manifestations and pathological changes are not fully matched,which could easily delay the diagnosis and treatment;? In order to improve clinical efficacy,aged calculous cholangitis patients need further classifying of severity after diagnosed,choosing the appropriate surgical time and surgical methods according to the severity and individualized characteristic;? Elderly patients with cholangitis were difficult to tolerate prolonged anesthesia and complex surgery.Thus,minimally invasive surgery which could provide fast recovery,safety and feasible was worth for clinical popularize;?the tranditional Chinese medicine QRLD which have the advantage in alleviate the symptoms of poisoning and restore the liver function was proved to has a significant clinical value in the treatment of patients with cholelithiasis cholangitis. |
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