75岁以上老年患者腹腔镜胆囊切除术

目的:评价腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗75岁以上老年患者胆囊疾病的疗效。方法:回顾分析2001年1月至2005年12月为75岁以上患者施行LC的临床资料。结果:75岁以上患者共110例,占全部LC的4.8%(110/2 270),平均77岁。其中80例(72.7%)合并不同程度的心血管疾病、慢性呼吸系统疾病或(和)糖尿病;15例(13.6%)有腹部手术史,15例(13.6%)伴有胆总管结石,术前或术后内镜下十二指肠乳头括约肌切开胆总管取石6例,腹腔镜下胆总管探查取石5例。LC中转开腹7例(6.4%),术后发生并发症6例(5.5%),其中局限性腹腔积液2例、心肌梗死2例、胆漏和胆管炎各1例;死亡1例(0.9%)。结论:选择LC治疗老年人胆囊疾病是安全、可行的;合并胆总管结石者可选择LC联合腹腔镜下胆总管探查取石或内镜下括约肌切开取石等微创措施,避免了开腹手术。

Laparoscopic cholecystectomy in patients aged 75 and over

Objective:To assess the outcome of laparoscopic cholecystectomy(LC) in patients aged 75 and over.Methods:The clinical data of aged patients 75 and over who underwent LC between January 2001 and December 2005 were evaluated retrospectively.Results:A total of 110 cases with a mean age of 77 years were included,who represented 4.8%(110/2 270) of all cases undergone LC.Eighty cases(72.7%) had variant degree of co-morbid disease such as cardiovascular diseases,chronic respiratory diseases or/and diabetes mellitus.Fifteen cases(13.6%) had history of previous intra-abdominal operations.Among 15 cases(13.6%) who had concurrent commonbile duct calculi,endoscopic sphincterotomy with calculi extraction was performed in 6 cases pre-or post-LC and laparoscopic exploration of common bile duct for cleaning calculi was performed in 5 cases simultaneously.Seven cases(6.4%) converted to an open procedure.Six cases(5.5%) developed postoperative complications:local intraperitoneal fluid collection in 2 cases,acute myocardial infarction in 2 cases,acute cholangitis in 1 case,and bile leak in 1 case.One case(0.9%) died for myocardial infarction after LC.Conclusions:LC as choice of treatment for aged patients with gallbladder diseases is safe and feasible.For cases complication with concurrent common bile duct calculi,minimally invasive methods such as laparoscopic clearance of calculi during LC or endoscopic sphincterotomy with calculi extraction should be preferable,and open procedures should be avoided.