老年患者腹腔镜胆囊切除术临床疗效及并发症危险因素分析

目的探讨腹腔镜胆囊切除术在老年患者的临床应用疗效并对并发症危险因素进行研究。方法根据治疗方法的不同将230例胆囊切除术老年患者分为开腹手术组（62例）及腹腔镜手术组（168例）,比较两组手术效果及术后胃肠功能恢复情况。同时采用Logistic回归分析腹腔镜胆囊切除术并发症危险因素。结果腹腔镜手术组手术时间、术中出血量、引流量、下床活动时间及住院天数显著少于开腹手术组（P〈0.05）;术后肛管排气时间及肠鸣音恢复时间显著早于开腹手术组（P〈0.05）;腹腔镜手术组共有13例（7.7%）患者发生术后并发症。胆囊壁厚、白细胞计数、Calot三角粘连、胆囊颈部结石嵌顿是腹腔镜术后并发症的风险因素,Calot三角粘连是术后并发症的独立风险因素。结论老年患者行腹腔镜胆囊切除术治疗对机体损伤小、术后恢复快,Calot三角粘连是术后并发症的独立风险因素。

Effects of laparoscopic cholecystectomy for elderly patients and the factors contributing to postoperative complications

Objective To understand the effects of laparoscopic cholecystectomy and the factors that cause postoperative complications in the process of treating elderly patients. Method 230 elderly cases undergoing laparoscopic cholecystectomy were selected as research subjects. The patients were divided into open abdominal operation group（ 62 cases） and laparoscopic operation group（ 168 cases） based on operative Method. The operation effect and recovery of gastrointestinal function were compared between the two groups. Risk factors of the operation-related complications were studied by Logistic regression analysis. Findings Laparoscopic surgery operative time,blood loss,drainage flow,leaving bed time and hospital stay were significantly less than the open surgery group（ P 0. 05）; postoperative anal exhaust time and time needed for intestinal voice restoration were significantly earlier than the open surgery group（ P 0. 05）; Postoperative complications was 7. 7%（ 13 cases） in the laparoscopic operation group. Univariate analysis showed that thethickness of gallbladder wall,leukocyte count,Calot triangle adhesion and gallbladder calculus were the risk factors for postoperative complications; Logistic regression analysis showed that Calot triangle adhesion was the independence risk factors for postoperative complications. Conclusion Laparoscopic cholecystectomy in elderly patients has less injury for body and faster recovery. Calot triangle adhesion was the independent risk factors for postoperative complications.