老年患者腹腔镜胆囊切除术与开腹胆囊切除术比较

A clinical comparison between laparoscopic and open cholecystectomy in elderly patients

目的对比研究老年良性胆囊疾病腹腔镜胆囊切除(laparoscopiccholecystectomy,LC)与开腹胆囊切除(opencholecystectomy,OC)安全性,为老年人胆囊切除术式的选择提供依据。方法60岁以上有胆囊切除适应证且耐受全麻的老年患者120例,按住院顺序单双号分为LC组和OC组,每组60例,比较手术时间、止痛剂使用情况、术后胃肠功能恢复时间、输液时间、卧床时间、术后并发症、住院时间等围手术期指标,比较2组总T3、TSH水平,腹肌功能恢复等康复指标。结果术后并发症、围手术期以及康复指标,LC组均优于OC组。TT3与术前相比,LC组(F=8·26,P=0·000)、OC组(F=124·70,P=0·000)均明显下降,OC组下降理明显;TSH与术前相比,LC组下降不明显(F=1·87,P=0·157),OC组下降明显(F=27·24,P=0·000)。术后7d直腿抬高试验次数LC组明显高于OC组(t=3·640,P=0·000)结论老年良性胆囊疾病患者行LC优于OC。

Objective To compare the safety between laparoscopic cholecystectomy （LC） and open cholecystectomy （OC） for benign gallbladder diseases in elderly patients. Methods A total of 120 patients above the age of 60 with indications for cholecystectomy and tolerance to general anesthesia were divided into two groups （ LC Group and OC Group） , in admission order of odd or even, with 60 patients in each group. Peri - operative parameters including operation time, analgetic consumption, postoperative gastrointestinal recovery time, length of duration with fluid infusion, length of bed rest, postoperative complications, and hospital stay were compared between the two groups. Serum total triiodothyronine （TT3 ） and thyroid stimulating hormone （TSH） levels, as well as the functional recovery of the abdominal muscles, were also recorded and compared. Results Peri - operative parameters were better in the LC Group than in the OC Group. Serum TT3 levels decreased significantly after surgery in both the LC Group （ F = 8.26,P =0. 000） and the OC Group （F = 124. 70 ,P = 0. 000） , with a more significant difference in the OC Group. Postoperatively, serum TSH levels decreased insignificantly in the LC Group （ F = 1.87,P = 0. 157 ） and significantly in the OC Group （ F = 27.24, P = 0. 000）.Lasegue＇ s test at 7 days after surgery showed significantly higher leg - raising times in the LC Group than in the OC Group （ t = 3. 640,P = 0. 000）. Conclusions Laparoscopic cholecystectomy is superior to open cholecystectomy in the treatment of benign gallbladder diseases in elderly patients.