老年急性结石性胆囊炎腹腔镜手术时机的探讨  

Opportunity of laparoscopic cholecystectomy in elderly patients with acute calculous cholecystitis

作　　者：张宗明[1] 魏文平[1,2] 刘卓[1] 田祖豪[1] 张翀[1] 刘立民[1] 于宏伟 万柏江[1] 刘子旭[1] 朱明文[1] 宋蒙蒙[1] 邓海[1] 谢朝辉[3] 

机构地区：[1]首都医科大学北京电力医院普外科,北京100073 [2]广东医科大学,524023 [3]首都医科大学北京电力医院健康管理部,北京100073

出　　处：《中华普外科手术学杂志（电子版）》2016年第5期406-409,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：国家电网公司科技基金资助项目(SGHB0000AJJS1400182)~~

摘　　要：目的探讨老年急性结石性胆囊炎(ACC)的手术时机,以期提高其腹腔镜手术治疗效果。方法本研究为2013年6月至2016年5月收治的79例老年ACC患者,根据其是否具有手术指征,随机分为手术组(40例)和非手术组(39例);手术组行腹腔镜胆囊切除术(LC),再根据术前发病时间早晚,分为早期LC组(<72 h)10例、晚期LC组(>72 h)30例。采用SPSS 18.0软件进行统计学处理。两组患者的血常规、高敏C反应蛋白、肝功能、血凝常规等指标以均数±标准差(x珋±s)表示,采用t检验进行比较;手术疗效以率(%)表示,组间比较采用t检验。P<0.05表示差异有统计学意义。结果术前手术组较非手术组年龄显著减小、血清总蛋白显著增高(P<0.05),两组的并存病、其余实验室检查结果均差异无统计学意义(P>0.05)。发病早期组(<72 h)与发病晚期组(>72 h)LC的手术成功率均为100%,两组的手术时间、术中出血量、术后住院天数无显著差异(P>0.05)。手术组治愈40例,治愈率100%。非手术组治愈27例,治愈率69.2%(χ2=14.512,P=0.001)差异有显著统计学意义。结论老年ACC患者既使发病时间超过72 h,腹腔镜胆囊切除术也是安全可行的,关键在于切实掌握手术时机、熟练掌握腹腔镜手术技巧,以期进一步提高老年ACC患者的腹腔镜手术治疗效果。Objective To investigate the opportunity of laparoscopic cholecystectomy（ LC） in elderly patients with acute calculous cholecystitis（ ACC）,so as to improve the clinical outcome of LC.Methods Clinical data of 79 elderly patients with ACC from June 2013 to May 2016,were analyzed retrospectively,including 40 cases in operation group and 39 cases in non-operation group. In the operation group,LC was divided into the early stage group（ 〈72 h,10 cases） and the late stage group（〉 72 h,30 cases） based on the preoperative time. Statistical analysis were performed by using SPSS 18. 0 software.Measurement data were presented as mean ± SD and examined by using t test,inclduing blood routine,high sensitive C reactive protein,liver function and blood coagulation routine. The efficacy were expressed as rate（ %） and test was used for comparison between two groups. A P value of〈 0. 05 was considered as statistically significant difference. Results Results Compared with no-operation group,age of patients in operation group was significantly decreased,and the preoperative serum total protein was significantly higher（ P〈0. 05）. There was no significant difference between the two groups（ P〈0. 05）,including the coexisting diseases and the other results of preoperative laboratory examination between the two groups. Success rate of LC was all 100% in both early onset group（ 〈72 h） and late group（ 〉72 h）. There was no significant difference in terms of operation time,blood loss,and postoperative hospital stay between 2 groups（ P〉0. 05）. There were 40 cases cured in the operation group,with the cure rate of 100%,while 27 cases were cured in non-operation group,with the cure rate of 69. 2%. The efficacy of the operation group was significantly better than that of non-operation group（ χ^2= 14. 512,P = 0. 001）. Conclusions Although the preoperative time is more than 72 h,LC in elderly patients with ACC is also safe and feasible,the key point is to effectively grasp the opportunity

关 键 词：胆囊结石病 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]