老年人腹腔镜胆囊切除术的特点

The characteristics of laparoscopic cholecystectomy in the elderly

目的 探索老年人LC的特点及围手术期处理。方法 回顾性分析了266例老年人(≥65岁)行腹腔镜胆囊切除术(LC)的手术时间、中转剖腹手术例数、住院天、手术并发症、围手术期肺功能和血气分析变化,分别与中青年病人LC及老年病人剖腹胆囊切除术(OC)比较。结果 老年人LC平均手术时间(39分)、手术中转率(5.6％)、手术并发症(5.3％)均高于中青年LC患者,而明显低于OC的老年病人,且并发症较轻。但老年人LC后的肺功能减退(10.2％)和高碳酸血症(20.3％)明显多于OC,多数可在术后短时间内恢复。结论 老年人LC仍不失为一种损伤小、安全可靠和恢复快的理想手术方法,但要针对老年病人的特点以及LC可能引起的肺功能下降和高碳酸血症,做好术前处理、术中及术后监测和并发症的预防。

To explore the characteristics of laparoscopic cholecystectomy in the elderly. Methods The results of laparoscopic cholecystectomy ( LC) in 266 elderly patients (≥ 65 yr)with benign lesions of the gallbladder were analysed retrospectively. In comparing with LC of young to middle aged patients and elderly with an open cholecystectomy ( OC) . Results The mean duration of the LC was 39 min, the conversion to an OC was 5.6%, and the complications was 5.2%. These numbers were more in elderly with LC than in young to middle aged patients and much less than elderly with OC. However the impairment of pulmonary function and hypercarbia were found in 10.2% and 20.3 % of elderly with LC respectively, which were much more than in the OC group. Most of the patients recovered in short peiod of time. Conclusion LC is an effective, safe and feasible operation in elderly. Some measures should be taken around the operations to protect impairment of pulmonary function, hypercarbia and the complications due to LC.