Objective To explore the option of conservative or surgical treatment in elderly patients with acute cholecystitis and choleli-thiasis. Methods A total of 170 elderly patients with acute cholecystitis and cholelithiasis were enrolled in this study,they were divided into study group(n = 92)with surgical treatment and control group(n = 78)with conservative treatment. The outcomes of treatment including com-plete remission of symptoms,hospitalization days,duration for starting eating and duration for recovery of intestinal function were compared. Re-sults Gallbladder stones were found in 92 cases(100% ),empyema in gallbladder in 26 cases(28. 26% ),gallbladder gangrene in 11 cases (11. 96% )and bile peritonitis in 6 cases(6. 52% )were found during operation. A total of 12 cases(13. 04% )had concurrent common bile duct stones or bile duct stricture. Complete remission of clinical symptoms and hospitalization days in study group were less than those in control group,but no significant difference had been found in other items. All patients were successfully treated with operation,and 6 cases had concur-rent respiratory tract infection,2 cases had pneumonia and one case had cardiac insufficiency after operation. Conclusion Early diagnosis and treatment,mastering strict surgical indications and perioperative proper treatment are key points for successful treatment in elderly patients with acute cholecystitis and cholelithiasis.%目的：探讨老年胆石症伴急性胆囊炎保守与手术治疗的选择。方法选择胆石症伴急性胆囊炎的老年患者170例为研究对象，手术治疗的患者纳入研究组（n ＝92），保守治疗的患者纳入对照组（n ＝78），比较两组临床症状完全缓解时间、住院时间、进食时间与肠功能恢复时间等治疗结果。结果术中发现胆囊结石共92例（100%），胆囊积脓26例（28.26%），胆囊坏疽11例（11.96%），胆汁性腹膜炎共6例（6.52%），并发胆总管结石共12例（13.04%）。研究组临床症状完全缓解时间、住院时间显著小于对照组，其余无显著差异。手术组患者均成功治疗，手术后并发上呼吸道感染6例，肺炎2例，心功能不全1例，无临床死亡。结论早诊断、早治疗，严格掌握手术适应证，在围手术期对基础疾病恰当处理，这些是老年急性胆囊炎伴胆石症治疗成功的关键。
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