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避免表现为急性胆囊炎的老年人胆囊癌行腹腔镜胆囊切除术。方法 :回顾了 1996～ 1999年 6 0岁以上表现为急性胆囊炎患者 2 8例 ,术中发现或术后病理证实为胆囊癌 6例 ,为一组 ,其余非肿瘤患者为一组 ,对照比较两组术前肝功能变化。结果 :肿瘤组 6例 ,3例行剖腹探查手术 ,2例由腹腔镜中转 ,1例腹腔镜术后拒绝再次手术 ;非肿瘤组 2 2例 ,行腹腔镜 12例 ,其中 5例中转手术 ;术前肿瘤组与非肿瘤组肝功能变化具明显差异 ,主要为总胆红 (93.4± 14 1.7) μmol/L和 (2 1.6± 12 .7) μmol/L ,P <0 .0 5 ,直接胆红素 (49.7± 81.0 )μmol/L ,和 (7.4± 4 .2 ) μmol/L ,P <0 .0 2 ,AST (91.0± 88.6 )IU/L和 (41.1± 2 6 .0 )IU/L ,P <0 .0 5 ,GGTP(5 5 3.9± 85 2 .1)IU/L和 (93.7± 98.4 )IU/L。P <0 .0 5 ,AKP(45 6 .5± 2 4 9.2 )IU/L和 (10 6 .3± 4 8.6 )IU/L ,P <0 .0 0 1。结论 :对于肝功能异常的老年人急性胆囊炎 ,应进一步完成影像学检查 ,对于此类病人 ,以开腹手术为好。
Avoid manifestations of acute cholecystitis in elderly patients with gallbladder laparoscopic cholecystectomy. Methods: Twenty-eight patients with acute cholecystitis who were over 60 years old from 1996 to 1999 were retrospectively reviewed. Six cases of gallbladder carcinoma were found or postoperatively pathologically confirmed as one group, and the other non-tumor patients were grouped as control group Preoperative liver function changes in both groups. Results: Tumor in 6 cases, 3 cases of laparotomy, 2 cases of laparoscopic transit, 1 case of laparoscopic surgery refused to re-operation; non-tumor group of 22 cases, laparoscopic 12 cases, including 5 cases of transit surgery; There were significant differences in liver function between preoperative tumor group and non-tumor group, which were mainly total bilirubin (93.4 ± 14 1.7) μmol / L and (21.6 ± 12.7) μmol / L, P <0.05, Bilirubin (49.7 ± 81.0) μmol / L and (7.4 ± 4.2) μmol / L, P <0. 02, AST (91.0 ± 88.6) IU / L and (41.1 ± 2 6 .0) IU / L, P <0.05, GGTP (5 5 3.9 ± 85 2 .1) IU / L and (93.7 ± 98.4) IU / L. P <0.05, AKP (45 6 .5 ± 2 4 9.2) IU / L and (10 6 .3 ± 4 8.6) IU / L, P <0.001. Conclusion: For acute cholecystitis in elderly patients with abnormal liver function, imaging examination should be further completed. For such patients, laparotomy is better.