85岁以上高龄患者的腹腔镜胆囊切除术  

Experience of laparoscopic cholecystectomy in patients over 85

作　　者：张磊[1] 曹铭辉[2] 商昌珍[1] 张红卫[1] 钟锋[1] 陈亚进[1] 

机构地区：[1]中山大学附属第二医院肝胆外科,广州510120 [2]中山大学附属第二医院麻醉科,广州510120

出　　处：《中国微创外科杂志》2007年第6期520-521,523,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的：探讨85岁以上超高龄患者行腹腔镜胆囊切除术（1aparoscopic cholecystectomy，LC）的可行性。方法1996年10月～2006年10月，对79例85岁以上高龄患者行LC术，术前控制合并症，持续性硬膜外麻醉，CO2气腹压8～10mmHg，三孔法操作。结果70例LC成功，9例（11．4％）中转开腹，其中6例因腹腔内粘连严重，1例因发生不易控制出血，2例因术中怀疑胆囊癌。术后并发症发生率12.7％（10／79），其中1例死于术后心肌梗死，另9例治愈，包括左心力衰竭1例，肺部感染2例，肠梗阻1例，穿刺孔血肿1例，真菌性肠炎1例，胆囊窝积液3例。结论：术前积极处理合并症，术中适度的气腹压力，熟练规范的手术操作，术后严密观察，对超高龄患者行LC安全可行。Objective To explore the feasibility of laparoscopic cholecystectomy （LC） in patients over 85 years old, Methods Three-port LC was performed in 79 patients aged over 85 years old from October 1996 to October 2006. Patients＇ comorbidities were effectively controlled before operation. The operation was conducted under continuous epidural anesthesia, and the CO2 pneumoperitoneum pressure was set at 8 ～10 mm Hg, Results The LC was successfully completed in 70 patients, while conversions to open surgery were required in 9 patients （ 11.4% ）. Causes of conversions included severe intraperitoneal adhesion in 6 patients, uncontrolled bleeding in 1 patient, and suspicion of gallbladder carcinoma in 2 patients. Postoperative complications occurred in 10 patients （12.7% , 10/79）. Of them, 1 patient died of acute myocardial infarction, and the remaining 9 patients were cured （including left heart failure in 1 patient, pulmonary infection in 2 patients, ileus in 1 patient, wound haematoma in 1 patient, fungal enteritis in 1 patient, and effusion in the gallbladder bed in 3 patients）. Conclusions Proper peri-operative management, effective control of co-morbidities, and careful surgical performance are essential for a safe LC in patients over the age of 85.

关 键 词：超高龄 腹腔镜 胆囊切除术 围手术期 

分 类 号：R657.4[医药卫生—外科学]