高龄老人急性结石性胆囊炎腹腔镜手术治疗经验  

Experience of laparoscopic cholecystectomy in elderly patients with acute calculous cholecystitis

作　　者：张宗明[1] 刘卓[1] 刘立民[1] 宋蒙蒙[1] 张翀[1] 于宏伟 万柏江[1] 刘子旭[1] 朱明文[1] 邓海[1] 杨海燕[1] 魏文平[1] 赵月 

机构地区：[1]首都医科大学北京电力医院普外科,北京100073

出　　处：《腹部外科》2017年第5期357-360,364,共5页Journal of Abdominal Surgery

基　　金：国家电网公司科技基金资助项目(SGHB0000AJJS1400182);北京市科技重大专项生物医药与生命科学创新培育研究(Z171100000417056)

摘　　要：目的探讨高龄老人急性结石性胆囊炎(acute calculous cholecystitis,ACC)的手术指征、时机和技巧,以期提高其腹腔镜手术治疗效果。方法收集首都医科大学北京电力医院普外科2013年7月至2016年11月收治的43例高龄老人(≥80岁)ACC病人的临床资料,平均年龄为(83.5±2.7)岁,根据其是否具有手术指征,分为手术组和非手术组,对其并存病、实验室检查、手术时机(术前发病时间、体温、血白细胞计数及中性粒细胞比例、高敏C反应蛋白)、手术效果(手术时间、术中出血量、术后住院天数)、术后并发症和治疗效果进行分析。结果 43例高龄老人ACC病人手术组17例,其中腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)13例(最大年龄88岁,成功率100%),开腹胆囊切除术(open cholecystectomy,OC)4例,非手术组26例。手术组较非手术组疗效显著提高(P=0.003),LC组治愈率(92.3%)显著高于OC组(75.0%)。手术时机对手术效果无显著影响(P>0.05),但对术后并发症有一定影响。结论高龄老人ACC病人LC是安全可行的,关键是掌握手术指征和时机、熟练掌握腹腔镜手术技巧,同时加强围手术期治疗,以期进一步提高其治疗效果和安全性。Objective Population aging in China is becoming a trend. This study aimed to investigate the operative indications,opportunity and skills of laparoscopic eholecystectomy （LC） in elderly patients with acute calculous cholecystifis （ACC） ,so as to improve the therapeutic effects of LC. Methods The clinical data of 43 elderly patients （over 80 years） with ACC were collected from July 2013 to November 2016 in our hospital. According to whether they had operative indications, the patients were divided into surgical group and non-operative group. The coexisting diseases,laboratory examination,operative opportunity （preoperative time, body temperature, blood leukocyte count and neutrophil percentage, high-sensitivity C reactive protein）, operative effect （operative time, intraoperative blood loss, postoperative hospital stay）, postoperative complications and therapeutic effects were analyzed. Results The average age of 43 elderly patients with AGOG was （83. 5 ± 2. 7） years old. Seventeen cases underwent surgical treatment,including 13 cases of LC （the maximum age of 88 years old,the success rate of 100%） ,and 4 cases of open cholecystectomy （OC）. Twenty-six cases received non-operative treatment. The therapeutic effects were significantly better in surgical group than in non-operative group （P = 0. 003）. The curative rate was significantly higher in LC group （92. 3 % ） than in 0（3 group （75. 0%）. The operative opportunity had no significant effect on the therapeutie effects （P〉 0. 05）, but had some effect on postoperative complications. Conclusions LC in elderly patients with AGOG is safe and feasible. The key is to reasonably determine the operative indications,effectively grasp the operative opportunity,expertly master the skills of LC,and improve the perioperative therapy,so as to further improve its therapeutic effect and safety.

关 键 词：高龄老人 急性结石性胆囊炎 腹腔镜手术 

分 类 号：R657.4[医药卫生—外科学]