老年患者行低气腹压腹腔镜胆囊切除术的可行性

Feasibility of Low-pressure Laparoscopic Cholecystectomy in Elderly Patients

目的探讨老年患者在低气腹压下行腹腔镜胆囊切除术的可行性。方法 2009年1月～2011年8月,对100例老年患者行腹腔镜胆囊切除术,其中51例低气腹压(6～8 mm Hg),49例常规气腹压(15 mm Hg)。比较2组手术时间、术中出血量、住院时间、术后并发症发生率等。结果 100例老年患者均顺利完成腹腔镜胆囊切除,无中转开腹。低压组手术时间(46.6±20.7)min与常规压组(42.7±22.3)min差异无显著性(t=0.907,P=0.367);低压组术中出血量(52.5±25.3)ml与常规压组(42.1±30.3)ml差异无显著性(t=1.867,P=0.065);低压组住院时间(4.9±2.6)d与常规压组(4.5±2.3)d差异无显著性(t=0.765,P=0.446);低压组术后并发症9例,与常规压组8例差异无显著性(χ2=0.031,P=0.860)。结论选择低压气腹对非高危病人是可行的,对高危病人是必要的,进行低气腹压LC安全可行。

Objective To discuss the feasibility of laparoscopic cholecystectomy （LC） under a low pressure for elderly patients. Methods From January 2009 to August 2011, we performed LC on totally 100 elderly patients. Fifty-one of them received low-pressure LC （6 -8 mm Hg）, and the other 49 patients underwent LC under a normal pressure （15 mm Hg）. The operation time, intraoperative blood loss, hospital stay, and rate of postoperative complications were compared between the two groups of patients. Results The procedure was completed in all the cases without conversion to open surgery. No significant difference was detected in the operation time, intraoperative blood loss, hospital stay, or rate of postoperative complications between the low- and normal-pressure groups [（46.6±20.7） minvs. （42.7±22.3） min, t=0.907, P=0.367; （52.5±25.3） mlvs. （42.1 ±30.3） ml, t=1.867, P=0.065; （4.9±2.6） dvs. （4.5±2.3） d, t =0.765, P=0.446; and 17.6%（9/51） vs. 16.3% （8/49）,X2 =0.031, P= 0. 860]. Conclusion Low-pressure LC is feasible and safe for elderly patients, it is advisable for non-critical patients, and necessary for critical patients.