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与开腹胆囊切除术比较

目的对比研究老年良性胆囊疾病腹腔镜胆囊切除(laparoscopic cholecystectomy,LC)与开腹胆囊切除(open cholecystectomy,OC)安全性,为老年人胆囊切除术式的选择提供依据. 方法 60岁以上有胆囊切除适应证且耐受全麻的老年患者120例,按住院顺序单双号分为LC组和OC组,每组60例,比较手术时间、止痛剂使用情况、术后胃肠功能恢复时间、输液时间、卧床时间、术后并发症、住院时间等围手术期指标,比较2组总T3、TSH水平,腹肌功能恢复等康复指标. 结果术后并发症、围手术期以及康复指标,LC组均优于OC组.TT3与术前相比,LC组(F=8.26,P=0.000)、OC组(F=124.70,P=0.000)均明显下降,OC组下降理明显;TSH与术前相比,LC组下降不明显(F=1.87,P=0.157),OC组下降明显(F=27.24,P=0.000).术后7 d直腿抬高试验次数LC组明显高于OC组(t=3.640,P=0.000) 结论老年良性胆囊疾病患者行LC优于OC.     

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。     

腹腔镜胆囊切除术后患者肝功能及免疫功能的变化

目的:观察腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)对患者肝功能及免疫功能的影响。方法:回顾分析2010年1月至2012年1月为胆囊结石患者行开腹胆囊切除术(open cholecystectomy,OC)(n=65)及LC(n=65)的临床资料,对比两组患者肝功能及免疫功能的变化。结果:两组患者术后血清ALT、AST、TBIL均较术前升高,术后第5天恢复至正常水平。术后第1天、第3天,OC组ALT、AST、TBIL水平明显低于LC组,差异有统计学意义(P<0.05);免疫学指标IgA、IgM、IgG两组患者手术前后均无明显改变,差异无统计学意义(P>0.05)。结论:LC可造成患者肝功能明显升高,但术后可迅速恢复,对免疫功能无影响。     

腹腔镜胆囊切除术中转开腹的原因分析及时机选择

目的:研究腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中转开腹的原因及时机。方法:将成功施行LC的胆囊炎合并胆囊结石患者归入LC组,中转行开腹胆囊切除术(open cholecystectomy,OC)的患者归入OC组,进一步根据中转开腹的时机分为主动中转组与被动中转组,以观察LC中转开腹的危险因素及术中、术后各项指标。结果:OC组上腹部手术史例数、急性胆囊炎发作例数、白细胞计数、胆囊壁厚度均大于LC组;主动中转组手术时间、术中出血量、输血例数、术后引流量、排气时间、下床时间、术后住院时间均明显优于被动中转组。结论:上腹部手术史、急性胆囊炎发作、白细胞计数偏高及胆囊壁厚度增加均是中转开腹的危险因素,根据术中探查情况选择合适的中转开腹时机具有积极的临床意义。     

胆囊结石并肝硬化患者行腹腔镜与开腹胆囊切除术的对比研究

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗胆囊结石合并肝硬化患者的优点、可行性和疗效。方法:胆囊结石合并肝硬化患者72例,随机分成LC组39例和开腹胆囊切除术(open cholecystectomy,OC)组33例,同组按编号、年龄、性别、肝功能分级等收集和分析数据。结果:LC组和OC组平均手术时间分别为(56.0±4.1)min和(70.8±5.2)min(P<0.05),术中平均出血量分别为(97.7±4.03)ml和(133.9±8.64)ml(P<0.05),平均住院时间分别为(6.2±1.9)d和(9.11±2.3)d(P<0.05),手术并发症发生率分别为10.2%(4例)和27.3%(9例)(P<0.05)。结论:胆囊结石合并肝硬化的患者用LC治疗优势明显,与OC相比更加安全可靠。     

老年人行腹腔镜胆囊切除术的特点

目的:探讨老年人腹腔镜胆囊切除术的特点。方法:分析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、住院天数、手术并发症、围手术期肺功能和血气分析变化,分别与中青年患者LC及老年患者剖腹胆囊切除术(OC)比较。结果:老年人LC平均手术时间为39min,手术中转率为5.6％,手术并发症占5.3％,均高于中青年LC患者,但明显低于OC的老年患者,且比较轻。但老年患者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:与OC比较,老年人LC仍是一种损伤小、安全可靠和恢复快的理想手术方法,但要针对老年患者的特点以及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。     

腹腔镜胆囊切除术对老年患者肝肾功能影响的临床研究

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)与传统开腹手术对老年患者肝肾功能的影响。方法:回顾分析2009年6月至2013年6月为118例70岁以上老年患者行胆囊切除术的临床资料,其中65例行LC(LC组),53例行开腹胆囊切除术(open cholecystectomy,OC组)。对比两组患者手术时间、术中出血量、术后住院时间、术后并发症及手术前后肝肾功能指标的变化情况。结果:118例患者均成功完成手术,LC组在术后住院时间、术后进食时间及术后并发症方面优于OC组(P<0.05);与术前相比,两组患者术后第1天肝功能指标AST、ALT、ALP、TBIL及肾功能指标BUN、SCr均有所升高,差异有统计学意义(P<0.05);术后第5天,LC组上述指标基本下降至术前水平,而OC组仍高于术前水平(P<0.05)。两组间相比,术后第1天、第5天,OC组患者AST、ALT、ALP、TBIL、BUN、SCr均高于同时点LC组(P<0.05)。结论:LC患者创伤小,术后康复快,对肝肾功能影响较小;在严格把握手术适应证的前提下,实施个体化治疗原则,为老年患者行LC是安全、可行的。     

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...     

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。     

Laparoscopic cholecystectomy in the elderly

BACKGROUND: The aim of this prospective study was to determine the feasibility and the complications or benefits of laparoscopic cholecystectomy (LC) in the patients older than 75 years. METHODS: From January 1992 to July 1998, a total of 863 patients underwent LC, of these patients, 102 patients older than 75 years (group 1) were compared with 761 younger patients (group 2). RESULTS: In the elderly, 35.3% were at high surgical risk (American Society of Anesthesiology [ASA] III and ASA IV). The conversion rate to open cholecystectomy (OC) was 21.6%. The mean length of hospital stay was 6.9 days for both laparoscopy and conversion. Morbidity and mortality rates were 13.7% and 1%, respectively. No patient suffered intraoperative cardiopulmonary complication, and there was no reoperation in the elderly. CONCLUSIONS: Elderly patients experience more complications and longer duration of hospital stay than younger patients. However, our results compare favorably with other OC studies in elderly patients.     

腹腔镜胆囊切除术对细胞因子、内皮素和C反应蛋白水平的影响

目的:探讨开腹与腹腔镜胆囊切除术(LC)2种方法对胆囊疾病患者血中细胞因子、内皮素和C反应蛋白的影响,比较两种方法对机体损伤的程度及安全性。方法:选择行剖腹胆囊切除术(OC)患者50例,LC患者50例,分别于术前和术后抽取静脉血检测IL-2、IL-6、NK细胞活性、CD4/CD8、内皮素、C反应蛋白含量并进行比较。结果:OC组IL-2和NK细胞活性术后较术前下降(P<0.05),IL-6术后较术前明显上升(P<0.01)。IL-6术后OC组较LC组上升(P<0.05)。OC组IL-2术后较LC组降低(P<0.05)。CD4/CD8未发现明显变化。OC组血中内皮素术后含量明显高于LC组患者(P<0.01),C反应蛋白于术后亦高于LC组。结论:研究表明LC损伤小,是一种安全可靠的手术方式。     

腹腔镜胆囊切除术对机体免疫功能的影响

目的：比较腹腔镜与开腹胆囊切除术对机体免疫功能的影响。方法：随机将有胆囊切除手术指征的80例患者分为2组,腹腔镜胆囊切除组（laparoscopic cholecystectomy,LC组）和开腹胆囊切除组（open cholecystectomy,OC组）各40例,测定并比较手术前后IgG、IgM、IgA,补体C3、C4水平及CD3^＋（T细胞总数）、CD4^＋（T辅助/诱导细胞）和CD8^＋的数量。结果：两组IgM、IgA、C4手术前后均无明显变化,两组间差异无统计学意义。LC组术后1d IgG、C3较术前有所下降,术后3d恢复至术前水平;OC组术后1d IgG、C3明显低于术前水平,术后5d恢复至术前水平;组间比较,OC组术后IgG、C3下降明显。LC组T淋巴细胞亚群手术前后差异无统计学意义,OC组术后1d CD3^＋、CD4^＋、CD8^＋与术前比较明显降低,术后5d恢复至术前水平;组间比较,术后1d、3d OC组CD3^＋、CD4^＋、CD8^＋均明显低于LC组。结论：腹腔镜手术对机体的免疫功能影响小,术后恢复快。     

咪唑安定、异丙酚麻醉诱导在老年人腹腔镜手术中的应用

目的 :观察咪唑定安、异丙酚麻醉诱导在老年人LC术的诱导效果和呼吸、循环的变化。方法 :选择ASAⅠ～Ⅲ级的老年LC手术患者 6 0例 ,随机分 3组 ,分别选用不同的麻醉诱导药物 ,Ⅰ组 (n =2 0 )采用咪唑安定 0 1mg/kg ,Ⅱ组 (n =2 0 )采用异丙酚 2 0mg/kg ,Ⅲ组 (n =2 0 )采用咪唑安定 0 0 5mg/kg与异丙酚1 0mg/kg合用。结果 :咪唑安定或异丙酚诱导 ,血压、心率波动较大 ,异丙酚组呼吸抑制程度明显高于其它两组 ,咪唑安定与异丙酚合用 ,麻醉诱导时间短、效果确切 ,整个诱导插管期间 ,血循环变化轻微 ,注药后虽有一过性呼吸抑制 ,但充分供氧后均可迅速恢复。结论 :咪唑安定合用异丙酚是老年人腹腔镜胆囊切除术的较为合理的麻醉诱导方法     

Variation in the use of laparoscopic cholecystectomy for elderly patients with acute cholecystitis

HYPOTHESIS: There is regional variation in the use of laparoscopic cholecystectomy (LC) for acute cholecystitis in the New England (Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and Connecticut) Medicare population. DESIGN: Population-based, cross-sectional study. SETTING: Hospital service areas (HSAs), small geographic areas reflecting local hospital markets, in New England. PATIENTS: We identified from the claims database 21 570 Medicare patients undergoing cholecystectomy between 1995 and 1997. Patients with acute calculous cholecystitis but no bile duct stones (n = 6156) were then identified using International Classification of Diseases, Ninth Revision diagnostic codes. To reduce variation by chance, we excluded patients residing in HSAs with fewer than 26 cases, leaving 5014 patients in 77 HSAs. MAIN OUTCOME MEASURES: For each HSA, we assessed the rate of cholecystectomies performed laparoscopically, mortality, and hospital length of stay. RESULTS: Overall, 53.5% of patients with acute cholecystitis underwent LC. There was wide regional variation in the rate of patients undergoing laparoscopic surgery, from 30.3% in the Salem, Mass, HSA to 75.5% in the Hyannis, Mass, HSA. Seventeen HSAs had rates below 40%, while 9 had rates above 70%. The average length of stay (7.6 days) was approximately 1 day shorter in HSAs with high rates of patients undergoing LC than in other HSAs. There was no correlation between regional use of laparoscopic surgery and 30-day mortality (3.1% overall). CONCLUSIONS: The likelihood of elderly patients with acute cholecystitis receiving LC depends strongly on where they live. Efforts to reduce regional variation should focus on disseminating techniques for safe LC in this high-risk population.     

腹腔镜与开腹胆囊切除术对老年患者术后应激反应和疲劳综合征影响的对比研究

目的:对比分析腹腔镜与开腹胆囊切除术时老年患者术后应激反应和术后疲劳综合征的影响,为腹腔镜胆囊切除术治疗胆囊结石的老年患者是否具有优越性提供客观依据.方法:筛选符合适应证的胆囊结石患者40例,随机分为腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）组和开腹胆囊切除术(open chol...     

762例老年患者行腹腔镜胆囊切除术的临床分析

目的:探讨老年患者胆囊结石特点,总结为老年患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的临床经验。方法:回顾分析1998年1月至2008年8月我院为762例60岁以上老年患者行LC的临床资料。结果:749例LC成功,其中行胆囊大部切除术5例,中转开腹13例,术中胆管损伤3例,胆漏3例,死亡1例,无其他严重并发症发生。结论:老年患者中急性胆囊炎和萎缩性胆囊炎所占比例较高,手术风险大。把握手术时机,积极处理合并症,为老年患者行LC是安全可行的。     

Microlaparoscopic vs conventional laparoscopic cholecystectomy

Background: Downsizing the port incisions may reduce pain after laparoscopic cholecystectomy. Methods: In a double-blind controlled study, 60 patients were randomized to undergo either microlaparoscopic cholecystectomy using one 10-mm and three 3.5-mm trocars (3.5-mm LC) or traditional laparoscopic cholecystectomy using two 10-mm and two 5-mm trocars (LC). Incisional pain at each port incision and overall pain were recorded for 1 week after the operation. Fatigue, nausea and vomiting, pulmonary function, and cosmetic results were also measured. Results: Data from 52 patients were analyzed; eight patients were excluded from the study for various reasons. One patient was converted from 3.5-mm LC to LC due to technical problems with the 3.5-mm optic. In the 3.5-mm LC group (n = 25), incisional pain was significantly decreased in the 1st postoperative week as compared with the LC group (n = 27) (p <0.01). In both groups, pain scores at the supraumbilical 10-mm port were significantly higher compared with other port sites (p <0.05). The cosmetic results were significantly better in the 3.5-mm LC group (p <0.01). There were no significant differences in any of the other variables. Conclusion: The use of 3.5-mm trocars is feasible in LC, and it both reduces incisional pain and improves the cosmetic result.