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中华肝脏外科手术学电子杂志 ›› 2024, Vol. 13 ›› Issue (06) : 754 -762. doi: 10.3877/cma.j.issn.2095-3232.2024993

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老年胆道外科热点问题的争议与思考
张宗明1,2,(), 董家鸿3, 何小东4, 王秋生5, 徐智6, 刘立民1,2, 张翀1,2   
  1. 1.100073 国家电网公司北京电力医院普通外科
    2.100073 北京,中国通用技术集团老年医学(肝胆)重点实验室(筹)
    3.102218 清华大学附属北京清华长庚医院肝胆胰中心
    4.100730 中国医学科学院北京协和医院基本外科
    5.100044 北京大学人民医院普通外科
    6.100191 北京大学第三医院普通外科
  • 收稿日期:2024-05-08 出版日期:2024-12-10
  • 通信作者: 张宗明
  • 基金资助:
    北京市科技重大专项生物医药与生命科学创新培育研究(Z171100000417056)国中康健集团科技项目(GZKJ-KJXX-QTHT-20230626)

Controversy and reflection on hot issues of biliary surgery in elderly patients

Zongming Zhang1,2,(), Jiahong Dong3, Xiaodong He4, Qiusheng Wang5, Zhi Xu6, Limin Liu1,2, Chong Zhang1,2   

  1. 1.Department of General Surgery,Beijing Electric Power Hospital of State Grid Corporation of China,Beijing 100073,China
    2.Key Laboratory of Geriatrics (Hepatobiliary Diseases) of GENERTEC (in preparation),Beijing 100073,China
    3.Hepatobiliary and Pancreatic Center,Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University,Beijing 102218,China
    4.Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China
    5.Department of General Surgery,Peking University People's Hospital,Beijing 100044,China
    6.Department of General Surgery,Peking University Third Hospital,Beijing 100191,China
  • Received:2024-05-08 Published:2024-12-10
  • Corresponding author: Zongming Zhang
引用本文:

张宗明, 董家鸿, 何小东, 王秋生, 徐智, 刘立民, 张翀. 老年胆道外科热点问题的争议与思考[J]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 754-762.

Zongming Zhang, Jiahong Dong, Xiaodong He, Qiusheng Wang, Zhi Xu, Limin Liu, Chong Zhang. Controversy and reflection on hot issues of biliary surgery in elderly patients[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(06): 754-762.

随着我国进入深度老龄化社会,老年胆道外科疾病发病率显著升高。针对老年胆道外科疾病患者病程进展快、术前合并疾病多、手术耐受力差、手术风险大、术后并发症多等临床特点,本文从腹腔镜手术指征拓宽、微创手术方式亟待规范、精准肝胆外科技术进步3个方面,就老年胆道外科的热点争议问题进行思考和评述,以期充分认识老年胆道外科疾病有关学术争议焦点,积极利用其有利因素,有效避免其不利因素,从而推动其治疗效果进一步提高,从而造福广大老年胆道外科疾病患者。

With China's entry into a deeply aging society,the incidence of biliary diseases in the elderly population has been increased significantly. In terms of the clinical characteristics of biliary diseases in elderly patients,such as rapid disease progression,multiple preoperative complications,poor surgical tolerance,high surgical risk and multiple postoperative complications,the hot controversial issues of biliary diseases in elderly patients were analyzed and elucidated from three perspectives including broadening the indications of laparoscopic surgery,urgently standardizing minimally invasive surgery,and improving the technologies of precision hepatobiliary surgery,aiming to fully understand the academic controversies of biliary diseases in elderly patients,actively utilize positive factors,effectively avoid negative factors,thereby enhancing therapeutic effect and bringing benefits to elderly patients with biliary diseases.

图1 一例高龄老年急性结石性胆囊炎合并门静脉高压症及Ⅴ型Mirrizi综合征患者LC术前CT和术中图像 注:a为术前CT显示胆囊壁明显增厚、双边征,胆囊内见多发斑点状稍高密度影;b为胆囊被大网膜包裹;c为胆囊壁与十二指肠融合;d为胆囊内多发结石;e为取出嵌顿结石后的胆囊颈部;f为胆囊颈部缝合处用可吸收夹加固(箭头所示);LC为腹腔镜胆囊切除术;该例患者为72岁女性
图2 一例90岁高龄女性AOSC患者的LTCBDE术前CT和术中图像 注:a为术前CT显示胆囊壁明显增厚、双边征,胆囊内见多发斑点状高密度影(箭头);b为胆总管内结节样稍高密度影(箭头);c为胆囊被大网膜包裹(箭头);d为胆囊壁充血、水肿严重(箭头);e为胆囊内脓液(箭头);f为缝针穿刺切开胆管法切开胆囊管(箭头);g为扩张胆囊管Heister瓣后插入胆道镜(箭头);h为胆囊管缝合处用可吸收夹(绿色箭头)加固,肝总管(蓝色箭头),胆总管(黑色箭头);i为胆道镜检查(绿色箭头)见胆总管下端结石(蓝色箭头);j为取出结石后胆道镜检查(绿色箭头)见胆总管下端(蓝色箭头)、肝门部胆管(红色箭头)无结石;AOSC为急性梗阻性化脓性胆管炎,LTCBDE为腹腔镜经胆囊管胆总管探查术
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