目的 探讨青年胆石症的临床特点,提高青年胆石症的预防、早期诊断和治疗效果.方法 回顾武汉大学人民医院2007年1月～2011年1月胆石症患者1 208例,18 ～45岁为青年组,60岁以上为老年组,将两组的病因、好发部位、临床表现进行对比研究.结果 ①危险因素:青年组与老年组的危险因素有显著差异(x2=25.351,P=0.005),青年组以肥胖(x2=8.874,P=0.005)为主,而老年组以糖尿病为主(x2=3.935,P=0.047).②好发部位:青年组尤其31～ 40岁者好发肝内胆管结石(x2=11.955,P=0.001),而老年组好发胆囊结石(x2=9.753,P=0.002).③临床表现:青年组的临床表现较轻,以腹痛为主(x2=6.216,P=0.013),常有右上腹压痛、墨菲氏征的典型体征,而老年组临床表现和体征不典型,主要表现为腹胀(x2=5.544,P=0.019),但可出现电解质紊乱、休克、神志障碍等严重临床表现及贫血等全身症状,与青年组有显著差异.结论 青年胆石症的主要危险因素为肥胖,临床表现明显较老年组轻,但也易误诊或漏诊,延误病情而导致急性化脓性梗阻性胆管炎,急性胰腺炎等严重并发症,增加死亡率.%Objective To discuss the clinical feature of youth cholelithiasis. Methods 1208 cases of cholelithiasis from 2007 ～2011 were analyzed retrospectively, which were divided into young group and old group. Etiopatogenisis, predilection site and clinical manifestaion were analyzed. Results There were significantly different in risk factors between two groups (χ2 = 25. 351, P =0. 005 ), the young group was mainly correlated with obesity (χ2 = 8. 874, P = 0. 005 ), while the old group was mainly correlated with diabetes mellitus (χ2 = 3. 935, P - 0. 047 ). Predilection site: the predilection site of young group, particularly 31 -40 years old, was intrahepatic bile duct (χ2 =11. 955, P = 0.001), but was gallbladder of the old group (χ2 = 9. 753 ,P =0. 002) . Clinical manifestations; the main clinical manifestation was bellyache (χ2 = 6. 216,P =0.013) and was accompanied with typical signs of right upper quedrant tenderness and Murphy's sign in young group; the main clinical manifestation was abdominal distension (χ2 =5. 544,P =0. 019) and occurred electrolyte imbalance, shock and consciousness disorders, besider symptoms of anemia in old group. Conclusion The youth cholelithiasis were mainly attribute to obesity, who were always misdiagnosed and increased mortality, because easily leaded acute obstructive suppurative cholangitis, acute pancreatitis and other serious complications.
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