65岁以上胆道疾病患者日间腹腔镜胆囊切除的安全性分析

A safety analysis of day-surgery laparoscopic cholecystectomy for elderly patients aged above 65 years with biliary tract diseases

目的探讨老年患者日间手术腹腔镜胆囊切除(LC/DS)的安全性。方法收集2009年11月-2015年7月于中国人民解放军总医院行LC/DS的4764例患者的临床资料。分析其中老年患者(≥65岁)的一般信息、手术时间、术中出血量、术后住院日、满意率、延迟出院原因、因心理因素延迟出院率、留置腹腔引流管延迟出院率、并发症发生率、中转开腹率、出院30 d内再入院率、病死率等,并与非老年患者(≤64岁)进行比较。非正态分布的计量资料2组间比较采用Mann-Whitney U检验;计数资料2组间比较采用χ~2检验。结果 710例老年患者与4054例非老年患者接受LC/DS,病死率为0。老年患者与非老年患者的手术时间[57.5(41.8~74.3)min vs 54.0(40.0~70.0)min,Z=-2.715,P=0.007]、术中出血量[10.0(5.0~20.0)ml vs 5.0(0~10.0)ml,Z=-8.604,P<0.001]、术后住院时间[1.0(1.0~1.0)d vs 1.0(1.0~1.0)d,Z=-3.778,P<0.001]、总延迟出院率(20.3%vs 14.8%,χ~2=13.637,P<0.001)、因心理因素延迟出院率(8.6%vs 6.5%,χ~2=4.220,P=0.040)和留置腹腔引流管延迟出院率(4.4%vs 2.0%,χ~2=13.909,P<0.001)比较,差异均有统计学意义;2组患者的并发症发生率(6.5%vs 5.9%,χ~2=0.334,P=0.563)、中转开腹率(0.8%vs 0.4%,χ~2=2.119,P=0.145)、出院30 d内再入院率(0.7%vs 0.5%,χ~2=0.190,P=0.663)比较,差异均无统计学意义。结论与非老年患者相比,老年患者LC/DS不存在更高的并发症、中转开腹和二次入院风险,是安全可行的。

Objective To investigate the safety of day - surgery laparoscopic cholecystectomy （LC/DS） in elderly patients. Methods The clinical data were collected from 4764 patients who underwent LC/DS in PLA General Hospital from November 2009 to July 2015, and a ret- rospective analysis was performed for the general data, time of operation, intraoperative blood loss, length of postoperative hospital stay, sat- isfaction rate, reason for delayed discharge, rate of delayed discharge caused by psychological factors, rate of delayed discharge caused by abdominal drainage tube placement, incidence of complications, rate of conversion to laparotomy, readmission rate with 30 days after dis- charge, and mortality rate of elderly patients （ t〉65 years）. The clinical data of elderly patients were compared with those of non - elderly patients. The Mann - Whitney U test was used for comparison of non - normally distributed continuous data between groups, and the chi - square test was used for comparison of categorical data between groups. Results A total of 710 elderly patients and 4054 non - elderly pa- tients underwent LC/DS, and no patients died. There were significant differences between these two groups in the time of operation [ 57.5 （41.8 -74.3） rain vs 54.0 （40.0 -70.0） rain, Z = -2. 715, P =0. 007], intraoperative blood loss [ 10.0 （5.0 -20.0） ml vs 5.0 （0-10.0） ml, Z= -8.604, P〈0. 001], length of postoperative hospitalstay [1.0 （1.0-1.0） d vs 1.0 （1.0-1.0） d, Z= -3. 778, P 〈 0. 001 ] , overall rate of delayed discharge （20.3% vs 14.8% , x^2 = 13. 637, P 〈 0. 001 ） , rate of delayed discharge caused by psychosocial factors （8.6% vs 6.5% , x^2 = 4. 220, P = 0. 040） , arid rate of delayed discharge caused by abdominal drainage tube placement （4.4% vs 2.0% , x^2 = 13. 909, P 〈0. 001 ）. There were no significant differences between the two groups in the incidence of complications （6.5% vs 5.9% , x^2 =0. 334, P =0. 563） , rate of conversion to laparotomy （0.8% vs 0. 4% ,x^2 = 2. 119, P = 0. 145 ） , and readmission rate within 30 days after discharge （0.7% vs 0.5 % , x^2 = 0. 190, P = 0. 663 ）. Conclusion Elderly patients undergoing LC/DS have comparable risks of complications, conversion to laparotomy, and readmission to non - elderly patients, which suggests that LC/ DS is safe and feasible.