Kirshtein Boris, Bayme Michael, Bolotin Arkady, Mizrahi Solly, Lantsberg Leonid
Department of Surgery "A" Soroka Medical Center, Department of Epidemiology, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Surg Laparosc Endosc Percutan Tech. 2008 Aug;18(4):334-9. doi: 10.1097/SLE.0b013e318171525d.
The purpose of this study was to evaluate the outcome of laparoscopic cholecystectomy (LC) in patients with acute cholecystitis aged 75 years and older.
A retrospective chart review was performed on the 1216 cholecystectomies performed in our department from 2000 to 2005. A total of 225 patients underwent attempted LC for acute cholecystitis, of whom 42 were more than 75 years old and 183 younger.
There was no difference in mean duration of symptoms before admission and length of hospital stay before surgery (3.8 d in elderly vs. 3.1 in younger patients, and 2.8 vs. 2.3 d, respectively). In all, 21% of the elderly patients had American Society of Anesthesiologists score III and IV. Mean operative time and conversion rate to open surgery were similar in both groups. Postoperative stay was longer in elderly (3.9 vs. 2.8). The postoperative complications rate and mortality were significantly higher in the elderly group (31% vs. 15%, and 4.8% vs. 0.5%, respectively).
LC in elderly patients suffering from acute cholecystitis is feasible and effective. It is associated with a higher rate of morbidity unrelated to the surgical site and mortality in elderly compared with younger patients. Stronger selection of elderly patients for surgery is needed.
本研究旨在评估75岁及以上急性胆囊炎患者行腹腔镜胆囊切除术（LC）的结果。
对2000年至2005年在我科进行的1216例胆囊切除术进行回顾性病历审查。共有225例急性胆囊炎患者尝试行LC，其中42例年龄超过75岁，183例年龄较小。
入院前平均症状持续时间和手术前住院时间无差异（老年患者为3.8天，年轻患者为3.1天；分别为2.8天和2.3天）。总的来说，21%的老年患者美国麻醉医师协会评分为III级和IV级。两组的平均手术时间和开腹手术转化率相似。老年患者术后住院时间更长（3.9天对2.8天）。老年组术后并发症发生率和死亡率显著更高（分别为31%对15%，4.8%对0.5%）。
老年急性胆囊炎患者行LC是可行且有效的。与年轻患者相比，老年患者手术部位无关的发病率和死亡率更高。需要更严格地选择老年患者进行手术。
