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目的探讨高龄老人急性结石性胆囊炎(acute calculous cholecystitis,ACC)的手术指征、时机和技巧,以期提高其腹腔镜手术治疗效果。方法收集首都医科大学北京电力医院普外科2013年7月至2016年11月收治的43例高龄老人(≥80岁)ACC病人的临床资料,平均年龄为(83.5±2.7)岁,根据其是否具有手术指征,分为手术组和非手术组,对其并存病、实验室检查、手术时机(术前发病时间、体温、血白细胞计数及中性粒细胞比例、高敏C反应蛋白)、手术效果(手术时间、术中出血量、术后住院天数)、术后并发症和治疗效果进行分析。结果 43例高龄老人ACC病人手术组17例,其中腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)13例(最大年龄88岁,成功率100%),开腹胆囊切除术(open cholecystectomy,OC)4例,非手术组26例。手术组较非手术组疗效显著提高(P=0.003),LC组治愈率(92.3%)显著高于OC组(75.0%)。手术时机对手术效果无显著影响(P>0.05),但对术后并发症有一定影响。结论高龄老人ACC病人LC是安全可行的,关键是掌握手术指征和时机、熟练掌握腹腔镜手术技巧,同时加强围手术期治疗,以期进一步提高其治疗效果和安全性。
Objective To investigate the surgical indications, timing and techniques of elderly patients with acute calculous cholecystitis (ACC) in order to improve their laparoscopic surgery. Methods The clinical data of 43 elderly patients (≥80 years old) with ACC admitted to Department of General Surgery, Beijing Medical College of Capital Medical University from July 2013 to November 2016 were collected. The mean age was (83.5 ± 2.7) years. According to whether they had Surgical indications were divided into operation group and non-operation group, and their complications, laboratory tests, operation time (preoperative onset time, body temperature, white blood cell count and neutrophil ratio, high sensitivity C-reactive protein) (Operation time, intraoperative blood loss, postoperative hospital days), postoperative complications and treatment effects were analyzed. Results Seventy-three elderly patients with ACC underwent surgery. Among them, 13 were laparoscopic cholecystectomy (LC), with a maximum success rate of 100% and open cholecystectomy (OC) 4 Cases, non-surgical group of 26 cases. The curative effect of operation group was significantly higher than that of non-operation group (P = 0.003). The cure rate of LC group (92.3%) was significantly higher than that of OC group (75.0%). The timing of surgery had no significant effect on the surgical outcome (P> 0.05), but had some effect on postoperative complications. Conclusions LC in elderly patients with advanced stage of the elderly is safe and feasible. The key is to master the indications and timing of operation, master the skills of laparoscopic surgery, and strengthen the perioperative treatment in order to further improve the treatment effect and safety.