不同年龄急性胆囊炎腹腔镜胆囊切除术中和术后并发症发生的危险因素分析

Risk of Complications during and after Laparoscopic Cholecystectomy for Acute Cholecystitis in Patients of Different Ages

目的分析不同年龄急性胆囊炎患者腹腔镜胆囊切除术(LC)术中和术后并发症发生风险的相关因素。方法选取2017年1月—2022年1月接受急诊LC的急性胆囊炎130例,按年龄分为A组(<50岁)48例、B组(50~60岁)42例、C组(60~70岁)23例、D组(≥70岁)17例。比较不同年龄患者术前一般资料,分析术中和术后并发症发生的危险因素。结果病程>48 h、合并症、东京指南标准(TG13/TG18)Ⅲ级、美国麻醉师协会身体状况分类(ASA-PS)≥Ⅲ级患者所占比例随年龄增长而增加,白细胞计数(WBC)、纤维蛋白原(Fb)、肌酐(Cr)、总胆红素(TBIL)水平升高均与年龄相关(P<0.05)。B组病程>48 h和Fb>400 mg/dl患者所占比例高于A组,C组和D组麻醉手术风险和疾病严重程度均高于A组(P<0.05)。B组术后引流量、并发症和中转开腹率高于A组(P<0.05);C组、D组手术时间、总住院时间和术后住院时间长于A组,术后引流量多于A组,并发症、中转开腹和开腹手术率高于A组(P<0.05)。多因素分析显示,年龄≥60岁、ASA-PS≥Ⅲ级、有合并症、坏疽性胆囊炎、Fb>400 mg/dl和TG13/TG18Ⅲ级与术后并发症的发生显著相关(P<0.05,P<0.01)。结论随着年龄增长,急性胆囊炎患者术后并发症也随之增多,年龄≥60岁、ASA-PS≥Ⅲ级、有合并症、坏疽性胆囊炎、Fb>400 mg/dl和TG13/TG18Ⅲ级是急性胆囊炎LC术后并发症发生的危险因素。

Objective To analyze the risk factors of intraoperative and postoperative complications of laparoscopic cholecystectomy(LC)for acute cholecystitis in patients of different ages.Methods A total of 130 patients with acute cholecystitis who received emergency LC from January 2017 to January 2022 were selected and divided into group A(<50 years,n=48),group B(50-60 years,n=42),and group C(60-70 years,n=23),and group D(≥70 years,n=17)according to the age.The preoperative general data of patients of different ages were compared,and the risk factors of intraoperative and postoperative complications were analyzed.Results The proportion of patients with disease duration>48 h,comorbidities,Tokyo guideline standard(TG13/TG18)gradeⅢ,and American Society of Anesthesiologists Physical Status Classification(ASA-PS)≥gradeⅢincreased with age,white blood cell count(WBC),and the levels of fibrinogen(Fb),creatinine(Cr),and total bilirubin(TBIL)increased with age(P<0.05).The proportion of patients with disease duration>48 h and Fb>400 mg/dl in group B was higher than that in group A,and the risk of anesthesia surgery and disease severity in groups C and D were higher than those in group A(P<0.05).The postoperative drainage volume,incidence of complications and the rate of conversion to laparotomy in group B were higher than those in group A(P<0.05).The duration of operation,total length of hospital stay and postoperative hospital stay in groups C and D were longer than those in group A,and the postoperative drainage volume was higher than that in group A;the incidence of complications,the rate of conversion to laparotomy and laparotomy were higher than those in group A(P<0.05).Multivariate analysis showed that age≥60 years,ASA-PS≥gradeⅢ,comorbidities,gangrenous cholecystitis,Fb>400 mg/dl and TG13/TG18 gradeⅢwere significantly correlated with postoperative complications(P<0.05,P<0.01).Conclusion Postoperative complications in patients with acute cholecystitis increase with age.Age≥60 years,ASA-PS≥gradeⅢ,comorbidities,gangrenous cholecystitis,Fb>400 mg/dl and TG13/TG18 gradeⅢare risk factors for postoperative complications of acute cholecystitis after LC.