Therapeutic experience of 289 elderly patients with biliary diseases

Zong-Ming Zhang, Zhuo Liu, Li-Min Liu, Chong Zhang, Hong-Wei Yu, Bai-Jiang Wan, Hai Deng, Ming-Wen Zhu, Zi-Xu Liu, Wen-Ping Wei, Meng-Meng Song, Yue Zhao, Zong-Ming Zhang, Zhuo Liu, Li-Min Liu, Chong Zhang, Hong-Wei Yu, Bai-Jiang Wan, Hai Deng, Ming-Wen Zhu, Zi-Xu Liu, Wen-Ping Wei, Meng-Meng Song, Yue Zhao

Abstract

Aim: To present clinical characteristics, diagnosis and treatment strategies in elderly patients with biliary diseases.

Methods: A total of 289 elderly patients with biliary diseases were enrolled in this study. The clinical data relating to these patients were collected in our hospital from June 2013 to May 2016. Patient age, disease type, coexisting diseases, laboratory examinations, surgical methods, postoperative complications and therapeutic outcomes were analyzed.

Results: The average age of the 289 patients with biliary diseases was 73.9 ± 8.5 years (range, 60-102 years). One hundred and thirty-one patients (45.3%) had one of 10 different biliary diseases, such as gallbladder stones, common bile duct stones, and cholangiocarcinoma. The remaining patients (54.7%) had two types of biliary diseases. One hundred and seventy-nine patients underwent 9 different surgical treatments, including pancreaticoduodenectomy, radical resection of hilar cholangiocarcinoma and laparoscopic cholecystectomy. Ten postoperative complications occurred with an incidence of 39.3% (68/173), and hypopotassemia showed the highest incidence (33.8%, 23/68). One hundred and sixteen patients underwent non-surgical treatments, including anti-infection, symptomatic and supportive treatments. The cure rate was 97.1% (168/173) in the surgical group and 87.1% (101/116) in the non-surgical group. The difference between these two groups was statistically significant (χ2 = 17.227, P < 0.05).

Conclusion: Active treatment of coexisting diseases, management of indications and surgical opportunities, appropriate selection of surgical procedures, improvements in perioperative therapy, and timely management of postoperative complications are key factors in enhancing therapeutic efficacy in elderly patients with biliary diseases.

Keywords: Biliary diseases; Elderly patients; Non-operative treatment; Surgical treatment.

Conflict of interest statement

Conflict-of-interest statement: The authors declare that there are no conflicts of interest related to this study.

Figures

Figure 1
Figure 1
Pancreatoduodenectomy in a 73-year old female patient with bile duct carcinoma. A: Three-dimensional computed tomography reconstruction found an extrahepatic bile duct obstruction (arrow); B: MRI coronal image confirmed entire extrahepatic bile duct obstruction (arrows); C: Tumor (arrow) seen at the incision of the common bile duct; D: Tumor (arrow) seen in the common bile duct by intraoperative choledochoscopy; E: Upper cut end of the hepatic common duct (arrows); F: The cut end of the pancreas (arrow), and the portal vein; G: Child anastomosis (arrows); H: Resected specimen following pancreatoduodenectomy; I: Papillary adenocarcinoma of extrahepatic bile duct, including the hepatic common duct, common bile duct and Vater ampulla. Hematoxylin and eosin staining. Objective magnification, × 40.
Figure 2
Figure 2
Laparoscopic cholecystectomy in a 78-year-old male patient with acute calculous cholecystitis. A: Pus (arrow) surrounding the gallbladder; B: Pus (arrow) in the lumen of the gallbladder; C: Congestion and edema of the gallbladder wall (arrow); D: Ordinary silk thread to ligate cystic duct (arrow); E: Inflammatory adhesion (arrow) of gallbladder bed; F: Wound after cholecystectomy.
Figure 3
Figure 3
Post-operative complications occurred in 68 elderly patients with biliary diseases.
Figure 4
Figure 4
Therapeutic outcomes in the surgical and non-surgical groups.

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