老年急性胆囊炎腹腔镜胆囊切除术时机及治疗体会

目的 探讨老年急性胆囊炎腹腔镜胆囊切除术时机及治疗体会.方法 回顾性分析112例老年急性胆囊炎行腹腔镜胆囊切除术患者的临床资料,发病72 h内入院者60例（早期手术组）,发病72 h以后入院者52例（晚期手术组）.比较两组手术时间、术中出血量、术后肠功能恢复时间、腹腔引流量、中转开腹率、住院时间的差异.结果 晚期手术组手术时间、术中出血量、术后肠功能恢复时间、腹腔引流量、住院时间均高于早期手术组（76.7±7.8） min比（54.3±4.8） min,（41.2±5.9） ml比（25.2±6.5）ml,（2.2±0.7）d比（1.4±0.6）d,（49.6±7.2）ml比（48.7±6.9）ml,（6.4±0.7）d比（3.9±0.6）d],差异有统计学意义（P＜0.05）.两组中转开腹率比较差异无统计学意义11.5％（6/52）比3.3％（2/60）,P＞0.05].结论 老年急性胆囊炎病情进展快,治疗难度大,风险高,早期采取腹腔镜胆囊切除术可明显缩短手术时间和住院时间,促进患者术后恢复.

Operation time and experience of laparoscopic cholecystectomy in elderly patients with acute cholecystitis

Objective To explore the operation time and experience of laparoscopic cholecystectomy in elderly patients with acute cholecystitis.Methods The clinical data of 112 elderly patients with acute cholecystitis were retrospectively analyzed,the patients were treated with laparoscopic cholecystectomy.According to the operation time,the patients were divided into early operation group （60 cases,the incidence of operation within 72 h） and advanced operation group （52 cases,the incidence of operation beyond 72 h）.The operation time,intraoperative bleeding volume,postoperative intestinal function recovery time,abdominal drainage volume,conversion rate and length of stay in hospital were compared between the 2 groups.Results The operation time,intraoperative bleeding volume,postoperative intestinal function recovery time,abdominal drainage volume and length of stay in hospital in advanced operation group were significantly worse than those in early operation group （76.7 ± 7.8） min vs.（54.3 ± 4.8） min,（41.2 ± 5.9） ml vs.（25.2 ± 6.5） ml,（2.2 ± 0.7） d vs.（1.4 ± 0.6） d,（49.6 ± 7.2） ml vs.（48.7 ± 6.9） ml,（6.4 ± 0.7） d vs.（3.9 ± 0.6） d],there were statistical differences （P 〈 0.05）.There was no statistical difference in the conversion rate between the 2 groups 11.5% （6/52） vs.3.3% （2/60）,P 〉 0.05].Conclusions The pathogenetic condition progress of acute cholecystitis in the elderly patients is quickly,and the treatment is very difficuh,high risk.Early laparoscopic cholecystectomy can shorten the operation time and length of stay in hospital,promote postoperative recovery.