老年人腹腔镜胆囊切除术1360例临床分析  

Clinical Analysis of 1360 Cases of Laparoscopic Cholecystectomy in Elders

作　　者：毛静熙[1] 陈训如[1] 罗丁[1] 余少明[1] 李胜宏[1] 周正东[1] 

机构地区：[1]成都军区昆明总医院肝胆外科,昆明650032

出　　处：《西南军医》2004年第4期20-22,共3页Journal of Military Surgeon in Southwest China

摘　　要：目的　以最少的创伤和并发症达到甚至优于传统胆囊切除方法治疗老年人的良性胆囊病变。方法　应用现代腹腔镜外科技术“四孔”或“三孔”法行胆囊切除 136 0例 ,其中择期手术 12 30例 ,急诊手术 84例 ,中转开腹手术4 8例。结果　腹腔镜胆囊切除 1314例 (96 6 % ) ,术中因胆囊及周围炎症重、粘连中转 4 0例 ,可疑胆囊癌中转 6例(病理确诊 3例 )。严重并发症 ,其中胆囊损伤 6例 ,胆瘘 2例 ,术后出血 2例 ,肝下间隙感染 3例 ,死亡 2例 (心脏病突发 )。一般性并发症 17例。结论　患胆囊良性病变的老年人有手术适应征 ,腹腔镜胆囊切除应是首选方法。近远期疗效明显优于剖腹手术。Objective To get the treatment results equal to or better than those with traditional open cholecystectomy for benign lesion of the gallbladder in elders.Methods The technique with three or four ports was applied in performing laparoscopic cholecystectomy in 1360 cases,out of which,1230 were selected cases and 84 emergent,46 cases were converted to open cholecystectomy.Results Laparoscopic cholecystectomy was carried out in 1314 cases (96.6%).40 cases were converted to open procedure associated with inflammation or adhesion around the gallbladder,and 6 cases were converted related to suspected gallbladder carcinoma,of which 3 cases were histologically confirmed.Severe complications were found in 6 cases,including bile duct injury or bile leakage in 2 cases,postoperative hemorrhage in 2,and infection in the subhepatic space in 2.Two patients died of attack of heart disease and stroke.Mild complications were noted in 17 cases.Conclusions Laparoscopic cholecystectomy is the first choice for elders with benign lesion of the gallbladder indicated for surgery;the long-term results are much better than those of laparotomic cholecystectomy.

关 键 词：腹腔镜手术 胆囊切除 老年患者 

分 类 号：R657.4[医药卫生—外科学]