老年腹腔镜胆囊切除术围手术期处理  

Perioperative Management of Laparoscopic Cholecystectomy in Elderly Patients

作　　者：尚培中[1] 周凤桐[1] 李永庆 贾国洪[1] 苗建军[1] 

机构地区：[1]解放军251医院普通外科,河北张家口075000 [2]锡林郭勒军分区医院外科,内蒙古锡林浩特026000

出　　处：《华北国防医药》2006年第5期320-322,共3页Medical Journal of Beijing Military Region

摘　　要：目的：探讨老年胆囊结石患者腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）的临床特点及围手术期处理。方法：回顾性分析1999年4月～2005年12月行LC的547例老年胆囊结石患者的临床资料。结果：547例中372例（68．0％）合并有不同程度的糖尿病、心血管疾病或支气管疾病。537例成功完成手术，8例中转开腹，2例放弃。合并心肌缺血、心律失常的87例中，术后46例症状及心电图明显改善。将注射用内给氧随术后静脉给药替代过去的吸氧以保持正常血氧饱和度。术后胆漏2例，分别经保守治疗、内镜鼻胆管引流治愈。结论：对老年LC应加强围手术期处理，灵活采取不同的处理方法。应用超声刀、低压气腹及内给氧有利于降低手术风险。Objective：To evaluate the clinical characteristics and features of laparoscopic cholecystectomy （LC） in elderly patients with gallstone. Methods：We reviewed clinical data of 547 elderly patients with gallston who received LC at our hospital during April 1999 and December 2005. Results：547 elderly patients with gallstone were accompanied by diabetes,and/or cardiovascular diseases or bronchitis. Laparoscopic cholecystectomy was completed successfully in 537 patients with 8 transferred to open cholecystectomy and 2 given up.46 cases with cardiovascular diseases improved in symptoms and/or on electrocardiograms. Carbamide proxide for injection took the place of oxygen. Bile leakage happened in 2 cases after operation which recovered after conservative management in one patient and endoscopic nasobiliary drainage in another. Conclusion ： Intensive perioperative management of laparoscopic cholecystectomy may reduce the operative risk. Harmonic Scalpel ,lower pneumatic abdomen and carbamide proxide for injection may increase the success rate.

关 键 词：胆石症 胆囊炎 胆囊切除术 腹腔镜 手术方法 老年病人 

分 类 号：R657.4[医药卫生—外科学]