90歳と100歳における胆管結石手術の経験

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  • TWO AGED PATIENTS WITH CHOLEDOCHOLITHIASIS

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We experienced 90- and 100-year-old patients with choledocholithiasis. Both patients had gangrenous cholecystitis. In the 90-year-old patient, the drainage of infected bile by percutaneous puncture of the gall bladder enabled an elective operation, for which the postoperative course was favorable. After cholecystectomy, choledocholiths were eliminated through the cystic duct without choledocholiths were eliminated through the cystic duct without choledochotomy. No T tube was employed, and the cystic duct was sutured for closure. The 100-year-old patient showed symptoms of peritonitis and underwent emergent-operation. To reduce the time of operation, choledochotomy was undertaken following cholecystectomy, and calculi confirmed by palpation were eliminated, after which a T tube was pleced. Aged patients with silent stones should undergo prophylactic cholecystectomy. Since long-term bed rest frequently causes disadvantages, it is unwise for patients to reveive T tubes. The removal of biliary calculi through the cystic duct seemed to yield more favorable results than that by choledochotomy. The 100-year-old patient was, to our knowledge, the oldest to have had such an operation in Japan.

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