腹腔镜胆囊切除术对老年患者肝肾功能影响的临床研究

Clinical study about influence of laparoscopic cholecystectomy on liver and renal function for the aged

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)与传统开腹手术对老年患者肝肾功能的影响。方法:回顾分析2009年6月至2013年6月为118例70岁以上老年患者行胆囊切除术的临床资料,其中65例行LC(LC组),53例行开腹胆囊切除术(open cholecystectomy,OC组)。对比两组患者手术时间、术中出血量、术后住院时间、术后并发症及手术前后肝肾功能指标的变化情况。结果:118例患者均成功完成手术,LC组在术后住院时间、术后进食时间及术后并发症方面优于OC组(P<0.05);与术前相比,两组患者术后第1天肝功能指标AST、ALT、ALP、TBIL及肾功能指标BUN、SCr均有所升高,差异有统计学意义(P<0.05);术后第5天,LC组上述指标基本下降至术前水平,而OC组仍高于术前水平(P<0.05)。两组间相比,术后第1天、第5天,OC组患者AST、ALT、ALP、TBIL、BUN、SCr均高于同时点LC组(P<0.05)。结论:LC患者创伤小,术后康复快,对肝肾功能影响较小;在严格把握手术适应证的前提下,实施个体化治疗原则,为老年患者行LC是安全、可行的。

Objective ：To explore the impact of laparoscopic versus open cholecystectomy （OC） for the aged on liver and renal function. Methods：A consecutive series of 118 patients over 70 years old underwent elective open or laparoscopic cholecystectomy （LC） between Jun. 2009 and Jun. 2013 ,including 65 patients in LC group and 53 patients in OC group, and their clinical data inclu- ding operation time,intraoperative bleeding, postoperative hospital stay, complications, and change of their liver and renal function be- tween pre- and postoperation were analyzed in a retrospective manner. Results ： All procedures were successfully accomplished, without conversion to open operation. There were no significant difference in operative time or intraoperative blood loss between the two groups. Compared with OC group,postoperative stay [ （9.1 ~ 1.6） d vs. （7.2 _＋ 1.4） d] ,time to start of diet [ （25.3 ＋4.2） h vs. （22.9 ＋ 4.1 ） h ] and complications after operation was less in LC group （ P 〈 0.05 ）. Compared with pre-operation, the indices of AST, ALT, ALP, TBIL, BUN, SCr significantly rised on the first day after operation in both groups （ P 〈 0.05 ）, but decreased to normal in LC group on the fifth day after operation, whereas the levels were still high in OC group. The levels of AST, ALT, ALP, TBIL, BUN, SCr were lower in LC group than those in OC group on the first day and the fifth day after operation （ P 〈 0.05 ）. Conclusions： LC is a safe and feasible surgical approach which has the advantages of minimal invasion, quick recovery ,little impact on liver and renal function, and is worthy to be generalized especially for the aged. The keys of the operation are strictly selected indication and individual treatment.