老年急性胆囊炎开腹胆囊切除与腹腔镜胆囊切除术的选择策略(附149例报道)

Selection Strategy of Elderly Patients with Acute Cholecystitis: Open vs. Laparoscopic Cholecystectomy

目的研究老年急性胆囊炎患者的手术方式。方法回顾性分析我院近13年间行手术治疗的149例老年(年龄≥60岁)急性胆囊炎患者的临床资料,根据手术方式分为开腹胆囊切除组(OC组,n=76)和腹腔镜胆囊切除组(LC组,n=73例)。比较2组患者手术时间、术中出血量、术后进食时间、肠道功能恢复时间、住院时间及并发症情况。结果OC组患者与LC组患者的一般情况除WBC计数和胆囊B超情况外,差异均无统计学意义(P>0.05);OC组术中出血量显著高于LC组,手术时间也显著长于LC组(P<0.01)。OC组住院时间、进食时间及肠功能恢复时间均显著长于LC组(P<0.01)。在并发症发生上,OC组有36例次,LC组有11例次,2组间差异有统计学意义(P<0.01)。结论老年急性胆囊炎患者的手术治疗应遵循个体化原则,选择OC或LC要视患者的总体情况而定,但均应以保证患者的安全为前提。

Objective To study the suitable operation method of elderly patients with acute cholecystitis. Methods The clinical data of 149 elderly patients with acute cholecystitis were retrospectively analyzed. All patients were divided into two groups according to the operation： open cholecystectomy group （OC group, n = 76） and laparoscopic cholecystectomy group （LC group, n= 73）. Some clinical data were compared in this paper such as operation time, blood loss, length of hospital stay, time of resumption of food, time of intestinal function recovery and complications. Results No marked difference was found between OC group and LC group about basic data except WBC count and examination of gallbladder by B ultrasound（P〉0.05）. But there were significant difference in operation time, blood loss, time of resumption of food, time of intestinal function recovery, length of hospital stay and complications between OC group and LC group （P〈0.01）. Conclusion Individualized treatment should be emphasized on elderly patients with acute cholecystitis. Selection of OC or LC to these patients should be based on the clinical condition and taken the safety as the first principle.