老年患者腹腔镜胆囊切除术后近期再手术41例临床分析

Clinical analysis of 41 recent reoperative aged patients treated by laparoscopic cholecystectomy JIANG

目的:探讨老年患者腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后近期再手术的原因及防范措施。方法:回顾分析1993年1月至2008年5月LC术后近期再手术的41例老年患者的临床资料。结果:经再手术治疗的41例患者中39例痊愈,其中再手术后发生并发症14例,包括切口感染2例,肺部感染5例,腹腔残余脓肿2例,胆管炎1例,应激性溃疡2例,下肢深静脉血栓形成2例,均对症处理,2例分别于再次手术后第3天、第5天死于应激性溃疡。结论:重视病史询问、完善术前检查、严格选择适应证、规范手术操作、适时中转开腹及针对老年患者采取特殊措施是减少老年患者LC术后近期再手术的关键。

Objective：To investigate the recent reoperative reasons and preventive measures of laparoscopic cholecystectomy（LC） in aged patients.Methods：The clinical data of 41 recent reoperative aged patients after LC from Jan.1993 to May 2008 were retrospectively analyzed.Results：Thirty-nine patients with re-operation were cured,14 of which developed postoperative complication respectively,including 2 incisional wound infections,5 pulmonary infections,2 abdominal residual abscesses,1 cholangitis,2 stress ulcers and 2 thrombogeneses in the deep veins of lower limb.All of them were expectantly treated,2 died from stress ulcer on the third and fifth day respectively.Conclusions：The keys to reduce recent reoperation of LC in aged patients are paying attention to inquiring case history,perfecting preoperative examination,selecting indications strictly,standardizing operative procedures,using laparotomy timely and adopting special measures for aged patients.