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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ERCP28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。
Objective To investigate the diagnosis and treatment of senile acute pancreatitis (AP). Methods The clinical data of 254 elderly patients (aged> 60 years old) with 5 years of hospitalized elderly acute pancreatitis were retrospectively analyzed. And compared with 258 hospitalized non-elderly patients with acute pancreatitis (control group, age <60 years). Results The elderly group, male: female = 1.00: 1.27. Biliary origin accounted for 70.9% of the causes. 218 of them were mild (MAP), 216 were cured, 2 died (0.92%), 36 were severe (SAP), 23 were cured and 13 died (36.11%). The mortality was related to age and severity (P <0.01). Control group, male: female = 1.00: 1.00. The incidence of biliary pathogens accounted for 46.1%. MAP 216 cases were cured, SAP 22 cases were cured in 19 cases, 3 patients died (13.6%). The levels of amylase (1054.97 ± 775.60) UU / L and total bilirubin (40.97 ± 37.11) μmol / L in the elderly group were significantly higher than those in the control group (P <0.05). The positive coincidence rate (68.9%) of the whole group of CT examination was significantly higher than that of B ultrasound (22.8%) (P <0.01). Surgical treatment of 65 elderly patients, 70 cases of ERCP 46 cases, 26 cases of conventional surgery, control group 51 cases of surgical treatment, including ERCP in 28 cases, 23 cases of conventional surgery. In the elderly group, there were 35 cases of different types of complications (13.8%) than the control group of 20 cases (7.8%) (P <0.05). Conclusion The majority of elderly AP gallbladder factors. Blood amylase and total bilirubin increased significantly; complications; high mortality. CT is AP’s preferred auxiliary examination. Treatment based on comprehensive treatment. ERCP for biliary obstruction, infection caused by the elderly patients with acute pancreatitis is more applicable. Elderly Severe Acute Pancreatitis high mortality, and increased with age.