高龄高危高难度腹腔镜胆囊切除术

Laproscopic cholecystectomy in elder patients

目的探讨高龄高危高难度腹腔镜胆囊切除(LC)主要并存病、并发症、手术时机、适应证及方法。方法回顾性分析1994年￣2004年12月实施503例LC的高龄高危高难度手术患者主要并存病、并发症、手术难度、围手术期处理等对其预后的影响。结果该组伴有糖尿病83例(16.50%),肺心病79例(15.71%),肝硬化69例(13.72%),冠心病206例(40.95%)。该组严重并发症发生率2.98%(15/503),死亡率0.80%(4/503),中转开腹率1.39%(7/503),治愈率99.20%。结论高龄高危胆囊炎患者并存病、并发症发生率高,尤其是急性胆囊炎发生率更高,并存病、并发症、手术难度大是引起死亡的高危因素。完善的围手术期处理,积极治疗并存病、并发症,严格把握手术时机、适应证,熟练的操作技能,恰当的手术方式是治疗成功的关键。

[Objective] To explore the serious complications of laproscopic cholecystectomy （LC） and its measures. [Methods] Restrospetive analyses of 503 patients of LC were made from 1994 to 2004 and their difficulty, high risk factors, serious complications and management as well. [Results] There were 83 （16.50%） cases with diabetes 79 （15.71%） with pulmonary heart disease, 69 （13.72%） with cirrhosis and 206 （40.95%） with coronary heart disease. Indications of serious complications were 2.98%, mortality 0.80% （4/503）, laparotomy 1.39% （7/503） and cure rate 99.20%. [Conclusions] Incidence of severe cholecystitis is high in the patients, especially with acute cholecystitis. High risk factors of death are caused by the complications and management of refractory surgery. On prevention, management of complications and the perfect skill in operation and its chosen time as well are the key points on operation to be successful.