老年及高龄胆囊结石诊疗困境与策略思考OA

With the acceleration of population aging in China,the incidence of gallstones among elderly and advanced-age individuals has continued to rise,seriously affecting patients'life expectancy and quality of life.Elderly patients often present with reduced physiological reserve,multimorbidity,and a mismatch between clinical manifestations and the severity of pathological injury,which markedly increases the difficulty of diagnosis and treatment.In recent years,the concept of precision individualized medicine has emphasized multidisciplinary comprehensive assessment and the implementation of a full-process management model of"screening-diagnosis-evaluation"for elderly patients,enabling early identification of high-risk populations and timely intervention.For patients with confirmed gallstones,it is essential to balance active intervention with surgical risk,formulate individualized treatment strategies,and determine the optimal timing for surgery.Laparoscopic cholecystectomy remains the treatment of choice,but the principles of damage control should be strictly followed.For high-risk patients,percutaneous transhepatic gallbladder drainage can be adopted as a bridging strategy in a"two-step"approach to reduce perioperative risk.Intraoperatively,indocyanine green fluorescence imaging or intraoperative ultrasound may assist in identifying anatomical structures;if necessary,subtotal cholecystectomy or timely conversion to open surgery should be performed to ensure safety.Refined perioperative management is a key component in promoting rapid recovery in elderly patients.In the future,big data and artificial intelligence may help establish risk prediction models tailored to the elderly population in China,facilitate the development of regional biliary disease centers,and ultimately achieve a closed-loop management model ranging from community screening to whole-process care.