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。     

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.     

老年人腹腔镜胆囊切除术临床分析

随着人口的老年化 ,胆囊疾病患者中老年人比例增加 ,由于老年患者常伴有心肺疾患 ,影响其对气腹的耐受性 ,故老年患者是否适于行腹腔镜胆囊切除术 (laparoscopiccholecystec tomy ,LC)仍有争论。本研究对比分析我们 2 0 0 0年施行LC的老年患者与非老年患者的临床资料 ,探讨老年胆囊疾病患者行LC的安全性。临床资料一、一般资料我们 2 0 0 0年施行LC 15 32例 ,其中 65岁及 65岁以上老年组 196例 ,65岁以下非老年组 1336例。老年组男 73例 ,女12 3例 ,最大年龄 85岁 ,平均 68.78岁 ,病程 1～ 480个月 ,平均83.3个月。非老年组男 463例 ,女…     

老年腹腔镜胆囊切除术480例麻醉分析

目的 探讨老年患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的可行性、安全性及围手术期的风险评估和处理.方法 回顾分析我院伴随内科合并症的480例老年患者行LC的临床麻醉资料.结果 所有患者均顺利完成麻醉和手术,无恶性心血管并发症及死亡病例的发生,术后恢复顺利.结论 伴随内科合并症的老年患者术前经积极处理,麻醉中防止血流动力学剧烈波动,维持心肌的氧供需平衡,调整好通气参数,在低气腹压下行LC是安全、可行的.     

老年患者行腹腔镜胆囊切除术的临床体会

目的：探讨腹腔镜手术治疗老年患者胆囊疾病的可行性及手术方法。方法：回顾分析2005年6月至2007年11月我院38例老年胆囊疾病患者行腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）的临床资料。结果：38例手术均获成功,手术时间35~110min,平均50min,术后住院4~12d,平均7.6d。术后发生胆漏3例,均经引流自愈,未发生其他严重并发症。结论：老年患者行LC手术难度大,风险高,手术关键是把握手术时机,并具备高水平的腹腔镜手术技巧,加强围手术期的处理。     

75岁以上老年患者腹腔镜胆囊切除术70例体会

目的探讨75岁以上老年患者腹腔镜胆囊切除术(LC)的安全性。方法回顾性总结70例75岁以上老年患者LC的中转率、术后并发症、住院时间、死亡率。结果70例患者总的中转率为8.6%,术后并发症、住院时间LC组均明显低于中转开腹组。全组无胆道损伤、无手术死亡。结论75岁以上老年人接受LC是安全的。     

老年患者行腹腔镜胆囊切除术的经验总结

目的探讨70岁以上老年患者施行腹腔镜胆囊切除术(laparoscopic cholecyestecomy,LC)的手术方法。方法回顾分析118例70岁以上老年患者行LC的临床资料。结果 115例LC获得成功,3例中转开腹。所有患者均治愈,无死亡病例。结论只要认真做好围手术期处理,70岁以上的老年患者行LC是安全可行的,具有较好的经济效益和社会效益。     

老年患者急症腹腔镜胆囊切除术55例体会

目的:总结55例老年患者行急症腹腔镜胆囊切除术(acute laparoscopic cholecystectomy,ALC)的体会。方法:回顾分析2002年1月至2007年12月55例老年患者行ALC的临床资料。结果:55例手术均获成功,手术时间40~130min;术中出血15~50ml;术后引流液为淡红色或淡黄色,30~150ml,3~5d拔除引流管;无术后出血及胆漏。仅1例剑突下戳口轻度感染,经抗感染及换药治疗5d痊愈。余者均痊愈出院,住院5~7d。结论:选择合适的手术时机,医师具备熟练的腹腔镜操作技术,老年患者行ALC是安全可行的,具有创伤小、康复快、痛苦轻的优点。     

老年患者腹腔镜胆囊切除术并发症的预防

目的 总结老年患者腹腔镜胆囊切除术及并发症预防的经验.方法 回顾性分析126例老年腹腔镜胆囊切除术的临床资料,其中急性胆囊炎22例,慢性胆囊炎104例.结果 腹腔镜胆囊切除术成功率90.5%,中转开腹手术12例(9.5%),术后并发症11例(8.7%).结论 老年患者腹腔镜胆囊切除术须加强围手术期的处理,才能更好地预防并发症.     

262例老年人腹腔镜胆囊切除术的临床分析

随着我国老年人口的逐年增加及饮食结构的变化,胆囊炎和胆囊结石已成为老年人群的常见病和多发病。LC(laparoscopic cholecytectomy)以其创伤小、术后病人疼痛轻及恢复快等优点为广大老年患者所接受,但老年胆石症患者因其年老体弱,常合并有其他系统的慢性疾病,增加了LC手术的风险。我     

老年人腹腔镜胆囊切除术118例报告

目的探讨老年人腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）的特点。方法回顾性分析2000年1月～2005年1月我院收治的118例老年病人LC的临床资料。结果116例顺利施行LC，中转开腹手术2例，其中1例为胆囊管开口于胆总管下端，另1例胆总管损伤。LC手术时间30～120min，平均50min。术后均恢复顺利。术后住院3～7d，平均4．5d。1例胆总管损伤术后随访2年6个月，有短暂的腹痛和发热，应用抗生素2—5d后症状消失，无胆道狭窄和胆道结石。余117例术后随访6～12个月，平均10．5月，无腹痛、发热、黄疸等并发症。结论老年人可耐受LC，且安全可靠，充分的围手术期处理、仔细的手术操作是成功的关键。     

急性胆囊炎腹腔镜胆囊切除术79例临床分析

目的总结腹腔镜下处理急性胆囊炎的临床经验. 方法回顾性分析2002年9月～2003年8月79例腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗急性胆囊炎(acute cholecystitis,AC)的临床资料. 结果 75例术中胆道造影成功,显示胆总管结石6例,其中4例行LC联合术中内镜括约肌切开取石,2例中转开腹行胆总管切开取石T管引流.单纯胆囊结石73例,70例LC成功,3例因炎症粘连明显而中转开腹.全组无严重并发症发生. 结论绝大多数急性胆囊炎行腹腔镜胆囊切除术安全可行.     

老年急性胆囊炎腹腔镜胆囊切除术

目的总结老年急性胆囊炎腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）经验。方法回顾性分析279例LC临床资料，其中急性结石性胆囊炎263例，单纯胆囊腺瘤8例，单纯胆囊息肉样病变5例，无明显原因3例。结果LC手术成功率87．5％（244／279），中转开腹手术35例，无严重并发症，无手术死亡。结论老年人常合并其他脏器疾病，LC围手术期危险性增高，应严格掌握手术适应证，正确处理合并症，术中放宽中转开腹指征是预防和减少并发症的关键。     

Laparoscopic cholecystectomy in the elderly

Background Few studies have examined the results of laparoscopic cholecystectomy (LC) in the elderly. We reviewed our experience with the procedure in 194 patients age 65 and older. Methods A chart review was performed on patients who underwent attempted LC over a 4-year period. Age, conversion rate to open cholecystectomy (OC), length of stay, and morbidity and mortality rates were compared between elective and inpatients as well as between patients age 65–75 and patients over age 75. Results Conversion rate to OC was 10.6%. Mean length of hospital stay was 2.7 days. Morbidity and mortality rates were 18% and 1%. Elective patients experienced significantly fewer medical complications. There were no differences in complication rates between patients age 65–75 and patients over 75 years, but younger patients had a significantly shorter mean length of hospitalization. Conclusions Elderly patients experience more complications and longer lengths of stay than the general population. However, our results compare favorably with OC series in elderly patients. Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Orlando, Florida, USA, 11–14 March 1995     

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。     

Laparoscopic cholecystectomy in the elderly.

OBJECTIVE: To evaluate the outcomes of laparoscopic cholecystectomy in elderly patients at a single institution. METHODS: A retrospective chart review was conducted of all patients > or = 65 years of age who underwent laparoscopic cholecystectomy over a 5-year period (January 1995 to December 1999). Four-trocar site laparoscopic cholecystectomy using the open Hasson technique were performed in all patients. The demographic data (age, sex), associated comorbidities, American Society of Anesthesiologist's (ASA) score, postoperative morbidity, mortality, and length of stay were recorded for each patient. Statistical analysis was done using Fisher's exact test and chi-square analysis. Statistical significance was defined as P < or = 0.05. RESULTS: The patient cohort included 46 patients with a median age of 71 years (range, 65 to 87). Seventeen (37%) patients were < or = 70 years of age, and twenty-nine (63%) patients were > or = 70 years of age. Twenty-two (48%) patients had ASA scores of > or = 3. Patients > or = 70 had significantly higher ASA scores. Eighteen patients > or = 70 years had ASA > or = 3 compared with 4 patients < or = 70 with ASA > or = 3 (P<0.05). Twenty-two patients > or = 70 and 8 patients < or = 70 required urgent surgery P<0.05). Fifteen (33%) patients presented with acute cholecystitis, and 31 (67%) patients presented with a greater number of chronic symptoms. Four (9%) patients had pancreatitis on presentation, and 6 patients underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP). Two of these 6 patients also underwent sphincterotomy. Urgent surgery was performed in 30 (65%) patients. The mean operative time was 103 +/- 37 (SD) minutes. One (2%) conversion to open cholecystectomy was required. The mean postoperative stay was 7 days (range, 1 to 46). Fourteen (30%) patients had only a 1-night postoperative stay. Patients > or = 70 had significantly longer postoperative stays. Nine patients > or = 70 and only 1 patient < or = 70 stayed in the hospital for more than 7 days. Postoperative complications were noted in 6 (13%) patients, most of which were chest infections. Five patients > or = 70 and only 1 patient < or = 70 developed postoperative complications. No mortalities occurred. CONCLUSION: Laparoscopic cholecystectomy is safe and feasible in elderly patients. Patients > or = 70 years seem to have a longer postoperative stay and slightly more postoperative complications. Age alone should not be a contraindication to laparoscopic cholecystectomy in the elderly patient.     

Laparoscopic cholecystectomy in cirrhotic patients

Background: This study aimed to evaluate the safety of laparoscopic cholecystectomy for patients with cirrhosis. Methods: The records of 22 laparoscopic cholecystectomies performed in patients with cirrhosis Child–Pugh A and B, from January 1995 to July 2001 were retrospectively reviewed. Results: No deaths occurred. Conversion to open cholecystectomy was necessary in two cases. The average operative time was 115 min, which was significantly shorter than that for patients undergoing open cholecystectomy. None of the patients required blood transfusion. Intraoperative problems occurred in two patients who experienced liver bed bleeding. Postoperative morbidity occurred in 36% of the patients and included hemorrhage, wound complications, intraabdominal collections, and cardiopulmonary complications, but all were controlled. The patients were dismissed after an average of 4 days. Conclusion: The authors believe laparoscopic cholecystectomy can be performed safely in selected patients with cirrhosis Child–Pugh A and B who manifest indication for surgery. Laparoscopic cholecystectomy offers several advantages over open cholecystectomy: lower morbidity, shorter operative time, and reduced hospital stay.     

Laparoscopic cholecystectomy for acute cholecystitis in elderly patients.

BACKGROUND: Acute cholecystitis is the major complication of biliary lithiasis, for which laparoscopic treatment has been established as the standard therapy. With longer life expectancy, acute cholecystitis has often been seen in elderly patients (>65 years old) and is often accompanied by comorbity and severe complications. We sought to compare the outcome of laparoscopic treatment for acute cholecystitis with special focus on comparison between elderly and nonelderly patients. METHOD: This study was a prospective analysis of 190 patients who underwent laparoscopic cholecystectomy due to acute cholecystitis or chronic acute cholecystitis, comparing elderly and nonelderly patients. RESULTS: Of 190 patients, 39 (21%) were elderly (>65 years old) and 151 (79%) were not elderly (< or =65 years), with conversion rates of 10.3% and 6.6% (P=0.49), respectively. The incidence of postoperative complications in elderly and nonelderly patients were the following, respectively: atelectasis 5.1% and 2.0% (P=0.27); respiratory infection 5.1% and 2.7% (P=0.6); bile leakage 5.1% and 2.0% (P=0.27), and intraabdominal abscess 1 case (0.7%) and no incidence (P = 1). CONCLUSION: According to our data, laparoscopic cholecystectomy is a safe and efficient procedure for the treatment of acute cholecystitis in patients older than 65 years of age.     

Laparoscopic cholecystectomy in geriatric patients

BACKGROUND: The results and advantages of laparoscopic cholecystectomy in the geriatric population have received minimal attention. Several early reports related high conversion rates complications and mortality. This case series review is focused on the results of laparoscopic cholecystectomy in the geriatric population in a private practice environment. METHODS: The records of all patients undergoing cholecystectomy by the author over the past 12 years were reviewed. The entire series consists of 248 patients in whom 239 procedures were completed laparoscopically, with 9 patients converted to an open cholecystectomy. This report identifies 82 patients who were aged 65 years or older at the time of the laparoscopic cholecystectomy. The results of this series are reported in three progressive geriatric age groups: 65 to 74, 75 to 84, and 85 to 95 years. RESULTS: All 82 geriatric patients reported from this series were symptomatic from their gallbladder disease. A majority of all patients in all age groups were female. Gallstones were present in 77 patients, and 5 patients had a gallbladder ejection fraction of less than 35%. In this series of laparoscopic cholecystectomy, 26.8% had an emergent procedure for acute cholecystitis and the remainder had an elective or semielective procedure for symptomatic cholecystitis. The majority of patients between the ages of 65 and 84 years had elective procedures whereas the majority of patients over age 85 had an emergent procedure. There were 2 deaths. The first death (age 86 years) was from extensive metastatic cancer from the gallbladder, and the second patient (age 91 years) died of sepsis and multiple system organ failure. Each patient in this entire series had an attempt at laparoscopic removal of the gallbladder. The conversion rate was 3.6% in the entire series of 248 patients and also 3.6% in the geriatric series. Ninety-one percent of the patients in this geriatric series were discharged home after only 24 to 48 hours of postoperative observation. CONCLUSIONS: Laparoscopic cholecystectomy is a safe procedure in the geriatric population. The procedure should be recommended for all geriatric patients who have symptomatic cholecystitis before the development of acute cholecystitis or severe fibrosis with dense adhesions from chronic cholecystitis.