老年患者腹腔镜胆囊切除术围手术期的处理

目的: 探讨老年人腹腔镜胆囊切除术的特点及围手术期处理。方法: 回顾性分析280例65岁以上老年患者行腹腔镜胆囊切除术的手术时间、住院天数、中转剖腹手术例数、手术并发症、围手术期肺功能和血气分析变化,分别与中青年人腹腔镜胆囊切除术及65岁以上老年患者剖腹胆囊切除术组比较。结果: 老年人腹腔镜胆囊切除术平均38 min,手术中转开腹率1.1%。手术并发症0.4%,略高于中青年(P<0.05),而明显低于65岁老年人开腹手术(P<0.01),且并发症轻。但老年人腹腔镜胆囊切除术后肺功能减退(10.0%)和高碳酸血症(20.0%)均高于开腹手术(P<0.01),但多数可在术后短时间恢复。结论: 65岁以上老年人腹腔镜胆囊切除术是一种损伤小、安全可靠、恢复快的理想手术方法。针对老年人合理周密的围手术期处理是保证老年患者耐受腹腔镜胆囊切除术的重要环节。

Management of the peri-operative period of laparoscopic cholecystectomy in the aged

Objective:To investigate the clinical features and management of the peri-operative period of laparoscopic cholecystectomy in the elderly.Methods:Two hundred eighty patients who were more than 65 years of age and had received laparoscopic cholecystectomy were analyzed retrospectively.The average duration of operation,average hospital stay,the number of cases changing to laparotomy,the complications and the changes of pneumonary function and blood gas were compared with those of the young patients receiving laparoscopic cholecystectomy and the aged patients performed laparotomy.Results:For the old patients receiving cholecystectomy,the average duration of operation was 38 minutes;the rate of changing to laparotomy was 1.1%;and the complication rate was 0.4%,which was higher than that of the young patients but lower than that of the aged patients receiving laparotomy(P<0.01).The occurrence of pneumonia dysfunction and hypercapnia(20.0%) in the patients treated by cholecystectomy was obviously higher than those by laparotomy (P<0.01),but most can recover quickly after operation.Conclusions:Laparoscopic cholecystectomy has the advantages of little injury and fast recovery for the aged patients.Rational and careful management in the peri-operative period can help the old patients withstand the laparoscopic cholecystectomy.