老年患者腹腔镜胆囊切除术围手术期的处理

Study on laparoscopic cholecystectomy in elderly patients during perioperative

目的总结老年患者行腹腔镜胆囊切除术围手术期处理的方法,为临床医生提供经验。方法回顾性分析笔者所在医院2010年1月～2012年1月23例老年胆囊炎患者实施腹腔镜手术治疗的资料,观察疗效并总结围手术期的处理经验。结果 53例患者腹腔镜手术均顺利获得成功,手术平均时间(50.0±12.7)min,下床活动时间(1.3±0.5)d,肛门排气时间(2.1±0.3)d,住院时间(6.3±1.8)d;其中中转开腹手术2例,均由于胆囊三角区粘连严重解剖关系分辨不清而开腹行胆囊切除。手术后有3例出现胆瘘,经保守治疗后得到痊愈,2例出现肺部感染,经抗炎对症治疗后痊愈。结论老年患者行腹腔镜胆囊切除术应严格掌握手术适应证,术前做好充分准备,对合并的慢性内科病进行全面评估,有效治疗,术中操作谨慎,严密监测术后生命体征,强化术中、术后预防并发症发生的意识,得到了满意的疗效,减轻了患者开腹手术带来的创伤,术后恢复快,并发症少。

Objective To summary the experience of laparoscopic cholecystectomy in elderly patients during perioperative.Methods The clinical data of 23 elderly patients with cholecystitis carried out laparoscopic surgery in the author＇s hospital from January 2010 to January 2012 were analyzed retrospectively.The therapeutic effects were observed and the experience of perioperative management were summarized.Results 53 patients undergoing laparoscopic operation were successful,the average operation time was（50±12.7） minutes,out-of-bed activity time was（1.3±0.5）days,anal exhaust time was（2.1±0.3） days,hospital stays was （6.3±1.8）days,of which 2 cases were converted to open operation,due to severe adhesion dissection of Calot＇s triangle relationship between resolution was not clear and open cholecystectomy.After operation with 3 cases of bile leakage after conservative treatment cured,2 cases of pulmonary infection,the anti-inflammatory treatment recovery.Conclusion Elderly patients undergoing laparoscopic cholecystectomy should be strictly controlled surgical indications,preoperative fully prepared to conduct a comprehensive assessment of the combination of chronic medical disease.