腹腔镜微创手术对高龄胆石症患者的治疗体会

Laparoscopic operation in the treatment of aged patients with cholelithiasis

目的 探讨高龄患者胆石症临床特点及总结腹腔镜微创手术对高龄患者胆石症的治疗经验.方法 回顾性分析2012年4月-2015年4月首都医科大学附属北京友谊医院门急诊收治的81例高龄患者胆石症手术患者的临床资料.对腹腔镜下胆囊切除术、腹腔镜下胆囊切除＋腹腔镜下经胆囊颈管胆道探查术、腹腔镜下胆道切开取石＋一期缝合3种不同手术方式患者的中转开腹率、肺炎患病率、心脑血管疾病患病率、胰腺炎患病率和胆瘘发病率进行比较.结果 单纯胆囊结石27例,26例顺利行腹腔镜下胆囊切除术,1例腹腔镜下胆囊切除术转开腹,术前可疑或确诊胆道结石54例,42例成功行腹腔镜下胆囊切除＋腹腔镜下经胆囊颈管胆道探查术,1例中转开腹,6例因胆道过细无法探查转行腹腔镜下胆囊切除术,胆道探查患者中5例既往已行胆囊切除,成功行腹腔镜下胆道切开取石＋一期缝合.术后胆瘘1例,胰腺炎2例,均保守治疗后痊愈.肺炎3例,1例转入感染病房进一步治疗,均痊愈出院.无胆瘘、胆道出血等胆道严重并发症的发生,无死亡病例.3组不同手术方式下患者的中转开腹率、肺炎患病率、心脑血管疾病患病率、胰腺炎患病率和胆瘘发病率的差异无统计学意义（P＞0.05）.结论 对于高龄胆石症患者,早期腹腔镜手术是安全可行的,但应做好围手术期管理,减少相应并发症的发生.

Objectives The purpose of this study was to investigate the characteristics of the aged patients with cholelithiasis and summarize the clinical application experiences.Methods A retrospective analysis was performed on aged patients with cholelithiasis treated by laparoscopic operation between Apr.2012 and Apr.2015.Studies which provided outcome data on aged patients, subjected to laparoscopic operation were considered.Mortality, morbidity, cardiac and pulmonary complications were the outcome measures of treatment effect.Results Twenty-seven patients had cholecystolithiasis, of whom laparoscopic cholecystectomy was successfully performed in twenty-six cases and one case was changed to transabdominal operation.Among the fifty-four patients with suspected or confirmed biliary calculi, laparoscopic cholecystectomy ＋ laparoscopic transcystic common bile duct exploration was successfully performed in forty-two cases and one case was changed to transabdominal operation.Six cases changed to cholecystectomy because of the diameter of the bile duct.Five patients who already had laparoscopic cholecystectomy received Ⅰ stage suturing of bile duct after the removal of the stones.Bile leak occurred in one case and pancreatitis occurred in three cases.Pneumonia occurred in three cases and one case was transmitted to the infection ward for further treatment.No severe procedure-related complication occurred.There was no significant difference in mortality, morbidity, cardiac and pulmonary complications.Conclusions Laparoscopic operation was acceptable for aged patients.Proper peri-operative management was essential to reduce the complications.