表现为急性胆囊炎的老年人胆囊癌

CARCINOMA INVOLVING THE GALLBLADDER IN ELDERLY PATIE NTS PRESENTING WITH ACUTE CHOLECYSITIS

避免表现为急性胆囊炎的老年人胆囊癌行腹腔镜胆囊切除术。方法 :回顾了 1996～ 1999年 6 0岁以上表现为急性胆囊炎患者 2 8例 ,术中发现或术后病理证实为胆囊癌 6例 ,为一组 ,其余非肿瘤患者为一组 ,对照比较两组术前肝功能变化。结果 :肿瘤组 6例 ,3例行剖腹探查手术 ,2例由腹腔镜中转 ,1例腹腔镜术后拒绝再次手术 ;非肿瘤组 2 2例 ,行腹腔镜 12例 ,其中 5例中转手术 ;术前肿瘤组与非肿瘤组肝功能变化具明显差异 ,主要为总胆红 (93.4± 14 1.7) μmol/L和 (2 1.6± 12 .7) μmol/L ,P <0 .0 5 ,直接胆红素 (49.7± 81.0 )μmol/L ,和 (7.4± 4 .2 ) μmol/L ,P <0 .0 2 ,AST (91.0± 88.6 )IU/L和 (41.1± 2 6 .0 )IU/L ,P <0 .0 5 ,GGTP(5 5 3.9± 85 2 .1)IU/L和 (93.7± 98.4 )IU/L。P <0 .0 5 ,AKP(45 6 .5± 2 4 9.2 )IU/L和 (10 6 .3± 4 8.6 )IU/L ,P <0 .0 0 1。结论 :对于肝功能异常的老年人急性胆囊炎 ,应进一步完成影像学检查 ,对于此类病人 ,以开腹手术为好。

Objective:To avoid the elderly patients with the gallbladder carcinoma presenting with acute cholecystitis to take laparoscopic cholecystectomy.Methods:Records of patients (60 years of age or older, 1996 to 1 999) with an admitting diagnosis of acute cholecystitis and symptom including ri ght upper quadrant pain, nausea, vomiting, fever, and/or leukocytosis were revi ewed.Results:Twenty eight patients were included in the study. Carcin o ma involving the gallbladder was found in six patients, all had primary carcinom a. The twelve patients without cancer underwent cholecystectomy. The differece b etween the noncancer and cancer patients included total bilirubin(umol/l, 21.6± 12.7 versus 93.4±141.7, P <0.05),direct bilirubin(umol/l, 7.4±4.2 versus 4 9.7±81.0, P < 0.02 ), aspartate aminotransferase(iu/l, 41.1±26.0 versus 91.0 ±88.6, P <0.05),r-glutamyl transpeptidase (iu/l, 93.7±98.4 versus 553.9± 852.1, P <0.05), andalkaline phosphatase(iu/l, 106.3±48.6 versus 456.5±24 9.2, P <0.001).Conclusions:Additional work up and open cholecystectomy should b e considered in elderly patients presenting with apparent acute cholecystitis, e specially when liver function is abnormal.