腹腔镜下胆囊切除治疗老年坏疽性胆囊炎的临床体会

The clinical experences on the treatment of elderly patients with acute gangrenous cholecystitis by laparoscopic cholecystectomy

目的探讨急性坏疽性胆囊炎(AGC)患者的临床特点及行腹腔镜下胆囊切除术(LC)的治疗体会。方法回顾性分析2011年12月至2013年9月间56例AGC患者行LC治疗的临床资料。以65岁为界,分为老年组39例和非老年组17例,分析其围手术期临床资料的差异,并探讨LC治疗AGC的手术技巧。结果术前相关临床资料显示老年组和非老年组合并心血管疾病的比率分别为76.9%和35.3%,差异有统计学意义(P<0.01)。老年组从发病至接受手术的时间明显较非老年组延长(P<0.01)。在手术时间、术后并发症方面两组无明显差异(P>0.05),但老年组的住院时间较非老年组延长(P<0.01)。结论对于AGC患者尤其是老年患者,临床医师必须充分判断病情的复杂性,手术过程中要掌握多种解剖入路及分离技巧,腹腔镜下微创优势同样可以在绝大多数AGC患者中得到体现。

Objective To investigate the clinical features and surgical treatment experience of acute gangre nous cholecystitis （AGC） by laparoscopic cholecystectomy （LC）.Methods The clinical data of 56 cases with AGC treated successfully by LC from Dec.2011 to Sep.2013 were retrospectively analyzed.The patients were divided into the elderly group （≥ 65 years,39 cases） and of non elderly group （＜65 years,17 cases）,and the difference of clinical data in perioperation period between the two groups were compared,and the operative technique was further discussed.Results The preoperative clinical data displayed that ratio of the elderly combined cardiovascular disease were significantly higher than that of non elderly group （P＜0.01）,and the elderly group from the onset to operation time obviously prolonged than that in the non elderly group （P＜0.01）.No significant difference （P＞0.05） was found about operation time and postoperative complications between the two groups.The hospitalization time was longer in elderly group than that in the non elderly group （P＜0.01）.Conclusion For AGC patients,especially elderly patients,surgeon must determine the complex condition,and master a variety of anatomic and separation technique in operation process,only in this way,the patients can get the minimally invasive advantages.