腹腔镜胆囊切除术对不同年龄段患者的疗效比较

Comparison of the effect of laparoscopic cholecystectomy between elder and middle age

目的评价与比较腹腔镜胆囊切除术（LC）对老年及中青年患者疗效的差异。方法选择2006—2011年因胆囊疾病行LC的患者388例，按年龄分为〈65岁组（中青年组）353例和≥65岁组（老年组）35例，比较两组患者手术时间、手术中转率、术后并发症、禁食时间、下床时间及术后住院时间，再将两组患者按病情轻重分为简单性胆囊疾病（复发性胆绞痛、慢性胆囊炎、胆囊息肉）和复杂性胆囊疾病（急性胆囊炎、胆囊积脓、急性胆囊炎穿孔）。分别比较不同病情患者年龄、术前白细胞计数（WBC）、手术时间、并发症及术后住院时间。结果两组手术时间、手术中转率、术后并发症、禁食时间、下床时间及术后住院时间比较差异均无统计学意义（P〉0．05）。简单性胆囊疾病及复杂性胆囊疾病行LC的患者在年龄及手术中转率方面比较差异无统计学意义（P〉0．05），但简单性胆囊疾病术前WBC、手术时间、并发症及术后住院时间均优于复杂性胆囊疾病[（7．32±2．12）×10^9／L,比（11．35±4．62）×10^9／L、（62．3±29．5）min比（79．5±49．2）min、3．1％（10／322）比9．8％（5／51）和（5．0±3．7）d比（7．9±6．5）d，P〈0．01或〈0．05]。结论年龄不是影响LC应用于老年患者的因素，但疾病本身病情轻重对手术有明显影响。

Objective To evaluate the curative difference of laparoscopic cholecystectomy （LC） between elder and middle age. Methods Patients with gallbladder disease who underwent LC from 2006 to 2011 were collected and divided into elder group （ ≥65 years old, 35 patients） and middle age group（ 〈 65 years old, 353 patients ）. The operation time, conversion rate, postoperative complications, time to first oral intake, time to first ambulation and hospitalization time were compared. These patients were divided into simple gallbladder disease group （included recurrent biliary colic , chronic cholecystitis, gallbladder polyps ） and the complex gallbladder disease group （included acute cholecystitis, gallbladder empyema, acute cholecystitis perforation）. The age,WBC, operation time,postoperative complicantions and hospitalization time were evaluated. Results The operation time, conversion, postoperative complications rate, time to first oral intake, time to first ambulation and hospitalization time had no significant difference between elder group and middle age group （P 〉 0.05 ）. The age, conversion rate between simple gallbladder disease group and complex gallbladder disease group had no significant difference （P 〉 0.05 ）. But the WBC, operation time, postoperative complications, hospitalization time in simple gallbladder disease group had significant difference compared with complex gallbladder disease group [ （7.32± 2.12） × 10^9/L vs. （11.35 ±4.62） × 10^9/L, （62.3 ± 29.5） min vs. （79.5 ±49.2） rain,3.1%（10/322） vs. 9.8%（5/51）, （5.0 ± 3.7） d vs.（7.9 ± 6.5） d,P 〈 0.01 or 〈 0.05 ]. Conclusions Age is not the risk factor of LC in elderly patients, but the disease type has a significant effect on the choice of LC.