不同年龄组腹腔镜胆囊切除术围手术期的临床分析

The clinical analysis of different age stages of laparoscopic cholecystectomy in perioperative period

目的:对比不同年龄胆囊结石患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)围手术期指标,探讨高龄患者的特点及手术治疗的安全性。方法:回顾分析为327例胆囊结石患者行LC的临床资料。将患者按年龄分为3组:高龄组(年龄≥75岁)、老年组(50≤年龄<75)、中青年组(年龄<50),对比分析3组患者合并症、术后并发症、住院时间、待手术日、手术时间、术后恢复时间、肠道功能恢复时间、术前白蛋白、术后第1天白蛋白及手术对患者白蛋白的影响。结果:在合并症方面,高龄组与其他两组相比差异有统计学意义(P<0.01),老年组与中青年组差异有统计学意义(P<0.05);3组患者手术并发症、手术时间、手术对患者白蛋白的影响差异无统计学意义(P>0.05)。高龄组住院时间、待手术日、术后恢复时间、肠道功能恢复时间、术后第1天白蛋白与其他两组相比差异有统计学意义(P<0.01),高龄组与老年组的术前白蛋白水平均低于中青年组,差异有统计学意义(P<0.01),高龄组与老年组相比差异亦有统计学意义(P<0.05)。结论:高龄组患者合并症较多,营养状况较差,但加强围手术期处理,高龄患者行LC仍是安全、可行的。

Objective：To compare the indexes among different age stages patients who underwent laparoscopic cholecystectomy because of gallstones during perioperative period, and investigate the characteristics and safety of surgical treatment in the senile pa- tients. Methods： A retrospective analysis was made on the clinical data of laparoscopic cholecystectomy for 327 patients with gallstones. The patients were allocated into three groups according to the age：senile aged group （age I〉75 years）, old aged group （50 ~〈 age 〈 75 ）, young and middle-aged group （ age 〈 50）. The difference of comorbidity, postoperative complication, total hospital stay, preoperative preparation time, operation time, postoperative recovery time, recovery time of intestinal function, preoperative level of albumin, level of albumin first day after operation and impact of surgery on albumin among the three groups were respectively compared. Results： The co- morbidity of senile aged group was statistically significant different compared with the other two groups （P 〈 0.01 ）, the difference was statistically significant between old aged group and the young and middle-aged group （ P 〈 0.05 ）. There was no significant difference in postoperative complications, operative time, impact of surgery on albumin among the three groups （ P 〉 0.05 ）. Compared with the other groups, senile aged group showed statistically significant difference in total hospital stay, preoperative preparation time,postoperative re- covery time, intestinal functional recovery time,level of albumin first day after operation （P 〈 0.01 ）. Both the senile aged group and old aged group were lower than the young and middle-aged group in preoperative level of albumin, the difference was statistically significant （P 〈 0.01 ） ,there were statistically significant differences in the senile aged group and old aged group. Conclusions：Although the se- nile patients have many comorbidities and poor physical conditions, as long as emphasizing the perioperative management and the opera- tive indications, laparoscopic cholecystectomy is safe and feasible in senile patients.