老年人腹腔镜胆囊切除术的特点

目的 探索老年人LC的特点及围手术期处理。方法 回顾性分析了266例老年人(≥65岁)行腹腔镜胆囊切除术(LC)的手术时间、中转剖腹手术例数、住院天、手术并发症、围手术期肺功能和血气分析变化,分别与中青年病人LC及老年病人剖腹胆囊切除术(OC)比较。结果 老年人LC平均手术时间(39分)、手术中转率(5.6％)、手术并发症(5.3％)均高于中青年LC患者,而明显低于OC的老年病人,且并发症较轻。但老年人LC后的肺功能减退(10.2％)和高碳酸血症(20.3％)明显多于OC,多数可在术后短时间内恢复。结论 老年人LC仍不失为一种损伤小、安全可靠和恢复快的理想手术方法,但要针对老年病人的特点以及LC可能引起的肺功能下降和高碳酸血症,做好术前处理、术中及术后监测和并发症的预防。     

老年人开腹和腹腔镜胆囊切除术临床对照分析

目的:比较老年人开腹(OC)和腹腔镜胆囊切除术(LC)的并发症和术后康复状况,评价老年人腹腔镜胆囊切除术的优越性。方法:前瞻性设计,随机将诊断为胆囊结石的老年患者分为两组,开腹组(OC)和腹腔镜组(LC)。对并发症和术后康复状况进行统计学处理。结果:OC组切口感染8例(28.6％),肺部感染7例(25.0％),低蛋白血症14例(50.0％)。LC组无切口及肺部感染,低蛋白血症5例(17.2％),胆漏1例(3％),皮下气肿2例,术中高碳酸血症3例,胆囊癌切口种植1例。结论:与OC相比老年胆结石患者施行LC具有并发症发生率低,住院时间短,康复快等优点。     

老年人腹腔镜胆囊切除的临床评价与风险防范

目的 :评价老年人腹腔镜胆囊切除术 (LC)的安全性及可行性 ,探讨防范风险的应对措施。方法 :比较、分析 6 0岁以上老年人LC组 (n =74 )、开腹胆囊切除 (OC)组 (n =36 )及中青年LC组 (n =2 82 )的临床资料。结果 :老年人LC及OC组并存病显著高于中青年LC组 (P <0 0 0 1 )。LC组患者术后恢复良好 ,未发生严重并发症 ;平均手术时间 ,平均术后住院天数及中转开腹率两组差异均无显著性 (P >0 0 5 ) ;而OC组平均手术用时、平均术后住院天数均显著延长 (P <0 0 0 1 ) ,且并发症多 (P <0 0 5 )。结论 :只要高度重视围手术期的处理 ,正确评估麻醉与手术的风险 ,把握手术时机及技巧 ,对老年患者施行LC不仅安全可行 ,而且更能凸现微创的优越性     

老年患者腹腔镜胆囊切除术320例临床分析

目的:评价老年人行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的安全性及可行性,探讨防范风险的应对措施。方法:比较、分析60岁以上老年人LC组(n=320)、开腹胆囊切除术(open cholecystectomy,OC)组(n=112)及非老年LC组(n=1 923)的临床资料。结果:老年人LC及OC组并存病显著高于非老年LC组(P<0.001)。LC组患者术后恢复良好,未发生严重并发症;老年LC与非老年LC在平均手术时间、平均术后住院天数及中转开腹率方面差异无统计学意义(P>0.05);而OC组平均手术时间、平均术后住院天数均较LC组显著延长(P<0.001),且并发症多(P<0.05)。结论:只要高度重视围手术期的处理,正确评估麻醉与手术的风险,把握手术时机及技巧,对老年患者施行LC不仅安全可行,而且更能凸显微创手术的优越性。     

腹腔镜手术治疗老年胆囊良性疾病的临床研究

目的探讨腹腔镜胆囊切除术(LC)治疗老年胆囊良性疾病的安全性和优越性。方法回顾性分析我院2006年6月—2009年6月完成的60岁以上老年人胆囊切除术110例的临床资料,结合患者意愿非随机分为腹腔镜手术(LC)和传统开腹手术(OC)两组,LC75例,OC35例。对比两组的手术疗效、安全性、手术时间、住院时间、术后并发症等情况。结果LC老年人可耐受,安全可行。患者术后恢复良好,未发生严重并发症。在平均手术时间,平均术后住院天数,术后并发症发生等方面均明显优于OC组(P0.05)。LC组中因粘连严重中转开腹1例。结论LC应用于老年病人更能体现微创的优越性。要根据老年病人的特点严格掌握手术适应证,积极做好围手术期的处理,正确评估麻醉与手术的风险,把握手术时机及技巧,以提高治愈率。     

老年肥胖患者胆囊切除的术式探讨

目的:探讨老年肥胖患者胆囊切除的最佳术式。方法:对68例老年肥胖患者不同术式胆囊切除进行回顾性分析。结果:腹腔镜胆囊切除术(LC)组并发症发生率(2.7％),明显低于开放性胆囊切除术(OC)组并发症发生率(16.1％),两者相比绝对并发症危险度(ARR)为13.4％;LC组住院天数、术后镇痛剂应用、恢复情况与OC组相比差异有显著意义(P<0.01)。结论:老年肥胖患者的胆囊切除应首选LC。     

老年人急性胆囊炎的腹腔镜手术治疗

目的探讨老年人急性胆囊炎采用腹腔镜手术治疗的临床效果与应用价值。方法回顾性分析105例因急性胆囊炎实施胆囊切除术的老年患者的临床资料,按手术方式分为腹腔镜组(LC组)和剖腹胆囊切除术组(OC组)。结果两组患者手术时间、肠功能恢复时间及住院天数差异均有统计学意义(P<0.01),LC组优于OC组;术中出血、腹腔引流量和术后并发症两组差异无统计学意义(P>0.05)。结论老年急性胆囊炎患者行腹腔镜治疗是安全可行的。     

腹腔镜和开腹胆囊切除术治疗慢性胆囊炎急性发作疗效分析

目的探讨比较腹腔镜和开腹胆囊切除术治疗慢性胆囊炎急性发作的临床效果。方法回顾性分析45例腹腔镜胆囊切除术(LC组)与48例开腹胆囊切除术(OC组)患者的临床资料,对比2组患者术中情况、术后恢复情况及并发症比例。结果LC组的手术时间、术中出血量、切口长度均少于OC组,差异有统计学意义(P均<0.01),其中LC组有2例术中转开腹手术;LC组住院时间、住院费用、肛门排气时间、术后疼痛时间、下床活动时间均少于OC组,差异有统计学意义(P均<0.01);而LC组和OC组的术后并发症发生率分别为6.7%和8.3%,差异无统计学意义(P>0.05)。结论腹腔镜胆囊切除术治疗慢性胆囊炎急性发作,与开腹手术比较,具有创伤小、疼痛轻、恢复快、并发症少的特点,值得临床推广应用。     

老年患者急性胆囊炎行腹腔镜胆囊切除术与开腹式胆囊切除术的疗效比较

【摘要】〓目的〓比较腹腔镜胆囊切除术(LC)与开腹式胆囊切除术(OC)治疗老年患者急性胆囊炎的安全性和有效性。方法〓选择从2007年1月至2012年12月收治的年龄超过70岁急性胆囊炎患者76例,分别采用LC(34例)与OC(42例)治疗。观察两组的手术时间、术中失血、术后住院时间和术后并发症。结果〓两组患者手术均顺利完成胆囊切除术,且LC组无中转开腹的病例。LC组的手术时间为95.2±19.7 min,OC组的手术时间为86.8±21.2 min,两者差异无统计学意义;LC组术中失血>500 mL的有2例(5.9%),OC组术中失血>500 mL的有8例(19.0%)(P<0.05);LC组的术后住院时间明显少于OC组(P<0.01)。总共有24例患者在术后出现了并发症(31.6%),其中LC组的术后并发症明显少于OC组(P<0.05)。结论〓急性胆囊炎老年患者行腹腔镜胆囊切除术治疗能缩短术后住院时间和减少术后并发症发生率。     

急诊高龄患者腹腔镜胆囊切除术和开腹胆囊切除术的临床对比研究

目的探讨急诊高龄患者腹腔镜胆囊切除术和开腹胆囊切除术的临床治疗效果。方法 101例高龄急诊胆囊炎患者分别施行腹腔镜胆囊切除(LC)和开腹胆囊切除(OC)两种手术方法治疗,LC组53例,OC组48例,观察手术恢复及并发症等情况。结果在手术时间、术中出血量、术后疼痛、肠道功能恢复时间、住院时间、并发症发生率等方面,LC组明显优于OC组。结论高龄患者急性胆囊炎行LC并发症少,创伤小、痛苦小、恢复快,高龄患者急性胆囊炎行LC是安全可行的,并具有微创的优势。     

腹腔镜胆囊切除治疗坏疽性胆囊炎的体会

目的 :探讨腹腔镜胆囊切除 (LC)治疗坏疽性胆囊炎的手术技巧。方法 :随机将 5 0例坏疽性胆囊炎分为 2组 ,由同一组手术医师分别行LC及开放胆囊切除 (OC)。结果 :手术时间、术后腹腔引流量两组相似。LC组术后患者下床活动时间早 ,肠功能恢复快 ,住院时间短。两组均未发生肝外胆管损伤、胃肠道损伤、胆漏等严重并发症。LC组中转OC率为 12 % ,并发症为 4 % ;OC组并发症为 16 %。结论 :在具有丰富LC经验的医师操作下 ,用LC治疗坏疽性胆囊炎安全可行。     

Pulmonary function after laparoscopic and open cholecystectomy

BACKGROUND: Laparotomy causes a significant reduction of pulmonary function, and atelectasis and pneumonia occur after open cholecystectomy. In this prospective, randomized study, we evaluated the hypothesis that pulmonary function is less restricted after laparoscopic cholecystectomy (LC) than after open cholecystectomy (OC). METHODS: Sixty patients underwent laparoscopic (n = 30) or open (n = 30) cholecystectomy. The two groups did not differ significantly in age, sex, intraoperative findings, and preoperative pulmonary function. Pulmonary function tests, arterial blood-gas analysis, and chest radiographs were obtained in both groups before operation and on postoperative day 1. RESULTS: The forced expiratory volume in 1 s (mean +/- SD values; OC, 1.49 +/- 0.77 L/s; LC, 2.33 +/- 0.80 L/s; p > 0.0001) and the forced vital capacity (OC, 2.40 +/- 0.66 L; LC, 2.93 +/- 1.05 L; p > 0.01) were more suppressed in patients having OC than in those having LC. Similar results were found for the peak expiratory flow (OC, 3.51 +/- 1.35 L/s; LC, 4.27 +/- 1.66 L/s; p > 0.05), expiratory reserve volume (OC, 0.73 +/- 0.34 L; LC, 0.92 +/- 0.43 L; p > 0.05), and the midexpiratory phase of forced expiratory flow (FEF25-75) (OC, 1.45 +/- 0.54 L/s; LC, 1.60 +/- 0.73 L/s; NS). Laparoscopic cholecystectomy was associated with a significantly lower incidence of (30 vs 70%) and less severe atelectasis and better oxygenation. CONCLUSION: Pulmonary function is better preserved after LC than after OC.     

Multivariate comparison of complications after laparoscopic cholecystectomy and open cholecystectomy.

OBJECTIVE: To answer the question whether laparoscopic cholecystectomy (LC) or open cholecystectomy (OC) is safer in terms of complications, the authors evaluated complications relating to 1440 cholecystectomies performed by the same surgeons in a retrospective study. SUMMARY BACKGROUND DATA: A definite pronouncement on whether LC truly is superior to OC is not possible because prospective trials are burdened with problems of recruitment. METHODS: After the introduction of LC at the authors' institution in April 1991 and until October 1993, 94.6% (700/740) of all patients admitted for operation because of symptomatic gallstone disease could be treated laparoscopically. The clinical records of the last 700 patients who underwent OC before the introduction of LC were re-evaluated with regard to both overall complications and the grade of complication (severity grade 1-4). A comparison of the incidence of complications relating to the two surgical methods, age, sex, common bile duct stones, acute cholecystitis, concomitant illness, Apache score, and length of operation was calculated by multivariate analysis using the logistic regression model. RESULTS: The total rate of complications in the OC group was 7.7%, with five postoperative deaths, compared with 1.9% and one postoperative death in the LC group. Multivariate analysis for OC revealed that both old age (p = 0.014) and the existence of common bile duct stones (p = 0.02) had independent prognostic influences in increasing the overall complication rate, whereas only old age (p = 0.019) influenced the overall complication rate after LC. Multivariate analysis of all cholecystectomies (n = 1440) showed that the overall complication rate was influenced independently by OC as a detrimental factor. CONCLUSIONS: As this analysis emphasizes, LC can be performed safely with an overall complication rate that is distinctly lower than that of OC. For selective surgery, LC is undoubtedly superior to OC and can probably be seen as a new "gold standard" for cholecystectomies.     

Does laparoscopic cholecystectomy worsen the prognosis of unsuspected gallbladder cancer?

BACKGROUND: Several reports claim that there is a risk that laparoscopic cholecystectomy (LC) might worsen the prognosis of unsuspected gallbladder cancer. HYPOTHESIS: Several factors rather than LC could influence prognosis. METHODS: A retrospective clinicopathologic study was performed on 20 patients, 9 patients (3 men and 6 women, aged from 36 to 75 years [mean age, 62.3 years]) undergoing LC and 11 patients (2 men and 9 women, aged from 53 to 91 years [mean age, 65.3 years]) undergoing open cholecystectomy (OC), with postoperatively diagnosed gallbladder cancer. The correlation was evaluated between cumulative survival rates and the following 7 prognostic factors: age, sex, histopathological grade, pathologic stage, occurrence of bile spillage, type of cholecystectomy (LC or OC), and additional surgical treatments. RESULTS: Seven patients (87%) after LC and 9 patients (82%) after OC had cancer recurrence: the difference is of no statistical significance (P =.9). There were no recurrences of cancer in the abdominal wall after either LC or OC. Survival rate was statistically correlated to tumor stage (P =.007) and to the occurrence of bile spillage (P =.002). Survival rate did not change according to whether the operation was carried out using LC or OC (P =.60). CONCLUSION: These results would seem to lend support to the opinion that LC does not worsen the prognosis for unsuspected gallbladder cancer.     

结石性胆囊炎腹腔镜与开腹胆囊切除术的对照研究

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)与开腹胆囊切除术(open cholecystectomy,OC)治疗结石性胆囊炎的疗效及并发症.方法:将343例结石性胆囊炎患者分为两组,220例行LC,123例行OC,观察两组手术时间、术中出血量、术后疼痛时间、肛门排气、术...     

腹腔镜胆囊切除术在老年胆囊结石中的应用

目的 :探讨腹腔镜胆囊切除术 (LC)在治疗老年胆囊结石中的临床价值。方法 :回顾分析LC和同期行开腹胆囊切除术 (OC)治疗老年胆囊结石患者各 10 1例的临床资料。结果 :在手术时间 ,术后肠功能恢复 ,切口感染及裂开 ,住院时间 ,原有心肺疾病有无加重等方面 ,LC组疗效均优于OC组 (P <0 0 1)。结论 :老年胆囊结石患者更适于应用LC ,积极治疗合并症 ,加强术中、术后监护 ,可使患者安全度过围手术期。     

Prospective study on patients outcome following laparoscopic vs. open cholecystectomy

AIMS OF THE STUDY: Differences in outcome between patients undergoing laparoscopic (LC) vs. open cholecystectomy (OC) should be examined under objective and subjective aspects. METHODS: We prospectively evaluated the postoperative course of 135 patients who underwent LC or OC in 1999. In the first step we examined the recover period with the help of the modified McPeek-Index. In the second phase during a 35 postoperative days-spanned analysis all patients noted there physical, emotional and social well-being in a circulating standard questionnaire, based on the modified Gastrointestinal Quality Life Index (GIQLI). RESULTS: Responses were obtained from 103 patients (76.3 %) undergoing 29 OC and 74 LC. 21.4 % of the patients aged 70 and older or had perioperative risks > II in ASA-Classification (LC 19.8 vs. OC 30.1 %). The (objective) McPeek-Outcome was similar in both groups, with no statistical advantage for LC (best score: 69 % LC vs. 62 % OC). The subjective assessment of the patients showed that patients having LC felt fully fit 10.2 days earlier than patients after OC (23.9 vs. 34.1 days). Patients in the LC-group returned to work after an average of 24.7 days, compared with 42.2 days following OC. The main finding of the postal questionnaire was a significantly earlier recruitment in physical, emotional and social status following LC in the group of aged > 70 and > ASA II-Score-patients, in contrast to control-OC-group. CONCLUSION: The study suggests an additional advantage in surgical outcome after LC, in comparison to OC. The laparoscopic approach is the preferable procedure to treat especially older and comorbide patients, when local or anesthesiological contraindications are absent.     

Laparoscopic cholecystectomy can be safely performed in a resource-limited setting: the first 49 laparoscopic cholecystectomies in Yemen.

BACKGROUND: Laparoscopic cholecystectomy (LC) is the gold standard for gallstone disease. Many studies have confirmed the safety and feasibility of LC and have shown that it is comparable regarding complications to open cholecystectomy (OC). The aim of this study was to evaluate the outcomes of LC including safety, feasibility in a resource-poor setting like Yemen, and also to compare the outcomes of LC with those of OC. METHODS: This was a prospective, nonrandomized, comparative study of 112 patients who were admitted to Alburaihy Hospital with a diagnosis of gallstone disease and underwent cholecystectomy from July 1998 to March 2004. Hospital stay, duration of operation, postoperative analgesia, and morbidity due to wound infection, bile leak, common bile duct (CBD) injury, missed CBD stone, bleeding, subphrenic abscess, and hernia were evaluated. Patients were followed up on an outpatient basis. RESULTS: Forty-nine patients underwent LC and 63 patients underwent OC. The mean age of LC patients was 43.96 years and of OC patients was 44.63 years. The 2 groups were similar in terms of age (p=0.740) and sex (p=0.535). No significant difference was found in the incidence of acute cholecystitis between the 2 groups (p=0.000). The mean operative duration for LC was 39.88 minutes versus 56.76 minutes for OC (p=0.000), and the mean hospital stay was 1.63 and 5.38 days for LC and OC, respectively (p=0.000). A drain was used frequently in OC (p=0.000). LC patients needed less analgesia (p=0.000). The morbidity rate in LC was 12.2% versus 6.3% for OC, which was not statistically significant (p=0.394), (p>0.05). Wound infection and bile leak were more common with LC. No mortalities were reported in either group. CONCLUSION: An experienced surgeon can perform LC safely and successfully in a resource-limited setting. As in other studies, LC outcomes were better than OC outcomes.