80岁以上老年急性结石性胆囊炎患者的临床治疗  

Surgical management of acute calculous cholecystitis in over 80 years of age patients

作　　者：程玉[1] 饶小惠[1] 张胜[1] 艾志国[1] 罗云藩[1] 邓予[1] 罗小平[1] Cheng Yu;Rao Xiaohui;Zhang Sheng;Ai Zhiguo;Luo Yunfan;Deng Yu;Luo Xiaoping(Department of Hepatobiliary Surgery,Huizhou Central People＇s Hospital,Huizhou 516001,China)

机构地区：[1]惠州市中心人民医院肝胆外科,广东省516001

出　　处：《中华普通外科杂志》2018年第7期567-570,共4页Chinese Journal of General Surgery

摘　　要：目的探讨80岁以上高龄老年急性结石性胆囊炎患者的临床特点及治疗。方法回顾性分析2006年9月至2016年9月收治的71例80岁以上急性结石性胆囊炎患者的临床资料．按照治疗方式分为三组，一期腹腔镜胆囊切除术（ laparoscopic cholecystectomy, LC ）组（25例），经皮经肝胆囊穿刺置管引流术（percutaneous transhepatic gallbladder drainage, PTGD）组（29例），PTGD后二期LC组（17例），分析各组患者的治疗情况。结果一期Lc组患者术前胆囊壁厚度大于二期Lc组，手术时间和术中出血量多于二期Lc组，差异有统计学意义。一期与二期LC组的其他基础资料以及住院时间、住院费用、术后并发症发生率、中转开腹率差异无统计学意义。一期LC组与PTGD组两组患者的基础资料比较差异有统计学意义，Logistic回归分析显示，TGl3分级是高龄老年患者选择PTGD而非一期Lc的重要影响因素（OR=3．957。P=0．015，95％CI：1．30—12，043）。结论对于可耐受手术的高龄老年急性结石性胆囊炎患者，可行一期Lc手术；对于不能耐受手术切除的患者，可先行PTGD后再二期LC切除。Objective To explore the clinical characteristics of acute calculous cholecystitis in over 80 years old patients. Methods A retrospective study was made on the clinical data of 71 cases diagnosed as acute calculous cholecystitis and receiving surgical treatment from Sep 2006 to Sep 2016. Patients were divided into three groups： Early LC group （25 patients）, PTGD group （ 29 patients）, the staged LC group （17 patients） after PTGD. Results There was statistically significant difference in the gallbladder wall thickness, operation time and blood loss between the two LC groups. There was no statistically significant difference between the two LC groups in other baseline data and hospital stay, hospital cost, rate of postoperational complication, rate of conversion to open procedure between the two LC groups. There was statistically significant difference between the early LC group and PTGD group in the baseline data. Logistic regression analysis indicated that the TG13 grade was an important influence factor for treatment selection of PTGD （ OR = 3.957, P = 0. 015, 95% CI： 1.30 - 12. 043 ）. Conclusion Laparoscopic cholecystectomy was safe for good risk over 80 years old patients. For poor risk patients, PTGD is recommended before a LC attempt.

关 键 词：胆囊炎 急性 胆囊切除术 腹腔镜 经皮经肝胆囊穿刺置管引流术 

分 类 号：R657.41[医药卫生—外科学]