超声刀和内给氧在老年人腹腔镜胆囊切除术中的应用

Application of Harmonic Scalpel and Carbamide Peroxide in Laparoscopic Cholecystectomy in Aged People

目的探讨超声刀及注射内给氧在老年人腹腔镜胆囊切除术(laparoscopiccholecystectomy,LC)中的应用效果。方法1999年4月～2005年2月运用超声刀及注射用内给氧行老年人(>60岁)LC357例。手术时间<2h者术后常规静脉输注注射用内给氧(过氧化碳酰胺)1g,根据血氧饱和度调整用量,<95%时予1g,<90%时予2g,必要时重复给药。手术时间>2h者,术中也可内给氧1～2g。结果351例成功完成LC,6例中转开腹。术后胆漏2例,分别经保守治疗、内镜鼻胆管引流治愈,死亡1例。317例予内给氧,平均用量1.4(1～6)g。随访274例,时间3个月～3年,未发现胆道并发症。结论对老年人LC应加强围手术期处理,灵活采取各种不同的处理方法。应用超声刀、低压气腹及内给氧有利于降低手术风险,提高手术安全性。

Objective To investigate the effect of application of harmonic scalpel and carbamide peroxide in laparoscopic cholecystectomy（LC） in aged people. Method 357 cases of old aged patients underwent LC with harmonic scalpel and received the carbamide peroxide treatment from April 1999 to February 2005. Carbamide peroxide was intravenously injected postoperatively in the cases when the operative duration was shorter than 2 hours, the routine dosage was 1 g and could be doubled if oxygen saturation drop down below 90%, and injection repeated when needed. Intraoperative injection of carbamide peroxide was optional if operative duration was longer than 2 hours. Result LC were successfully done in 351 cases besides 6 cases of conversion to open surgery. Postoperative bile leakage occurred in 2 cases which conservatively cured with endoscopic nasobiliary drainage. There was 1 death. 317 cases received carbamide peroxide treatment with a mean dosage of 1.4 g. No biliary complication occurred with 3 months to 3 years follow-up in 274 cases. Conclusion The application of harmonic scalpel and carbamide peroxide treatment in LC of old patients can reduce the risk of the operation.