老年急性胆囊炎合并基础疾病患者行腹腔镜胆囊切除术的手术时机探讨  

Operation opportunity of laparoscopic cholecystectomy for senile patients with acute cholecystitis combined with underlying disease

作　　者：单强[1] 胡娟英[1] 许明辉[1] 廖韶民 王虎[1] 沈巍[1] 

机构地区：[1]海宁市人民医院普外三科,浙江省海宁314400

出　　处：《中国基层医药》2015年第24期3723-3725,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：探讨老年急性胆囊炎合并基础疾病患者行胆囊切除术的手术时机。方法急性胆囊炎合并基础疾病行胆囊切除术的老年患者82例，根据患者手术时间的不同分为两组：早期手术组和延迟手术组，每组患者各41例，早期手术组患者于发病后72 h 内进行手术，延迟手术组患者于发病后超过72 h 进行手术。观察并比较两组患者的手术时间、术中出血量、术中组织粘连情况、术中渗出情况、住院时间、住院费用以及并发症的发生情况。结果早期手术组和延迟手术组患者手术时间分别为（45．32±12．23）min、（50．89±13．34）min，两组差异无统计学意义（P ＞0．05）；延迟手术组术中粘连情况多于早期手术组，而早期手术组术中出血量和渗出情况均显著高于延迟手术组（均 P ＜0．05），而住院时间和住院费用均显著低于延迟手术组（均 P ＜0．05）。早期手术组患者术后发生肺部感染1例、切口感染3例，并发症发生率为9．76％；延迟手术组1例患者行中转开腹手术，肺部感染2例、切口感染4例，并发症发生率为14．63％，两组差异无统计学意义（P ＞0．05）。结论老年急性胆囊炎合并基础疾病患者行胆囊切除术早期手术即72 h 内手术是最佳手术时机。但对于由于各种原因，不能立即进行手术的患者，行延迟胆囊切除术也是安全可行的。Objective To explore the operation opportunity of cholecystectomy for senile patients with acute cholecystitis combined with underlying disease.Methods 82 elderly patients with acute cholecystitis complicated with underlying diseases underwent cholecystectomy were selected,they were divided into two groups according to the different operation time：the early operation group and the delayed operation group,41 cases in each group.The patients in early operation group were given operation in 72h,while the delayed operation group was given operation more than 72h after attack.The operation time,intraoperative blood loss,intraoperative tissue adhesions,intraoperative exudation,hospitalization time,cost of hospitalization and complications of the two groups were observed and com-pared.Results The operation time of the two groups were （45.32 ±1 2.23）min,（50.89 ±1 3.34）min,there was no significant difference （P 〉0.05）,the intraoperative tissue adhesions of the delayed operation group was more than the early operation group,and the intraoperative hemorrhage and exudation in the early operation group were significantly higher than those of the delayed operation group （P 〈0.05）,and the hospital stay and cost of hospitalization were sig-nificantly lower than those of the delayed operation group （P 〈0.05）.1 case in the early operation group occurred pulmonary infection,3 cases with incision infection,the incidence of complications was 9.76%;1 case in the delayed operation group underwent laparotomy operation,2 cases in the delayed operation group had pulmonary infection,inci-sion infection in 4 cases,the incidence rate of complication was 1 4.63%,there was no significant difference between the two groups （P 〉0.05）.Conclusion The optimal operation timing of acute cholecystitis combined with basic dis-eases in the elderly patients underwent cholecystectomy is within 72h.For patients who can not be immediately given operation due to various reasons,delayed cholecystectomy is safe and feasible.

关 键 词：胆囊炎 急性 胆囊切除术 腹腔镜 老年人 

分 类 号：R657.4[医药卫生—外科学]