Yetkin Gurkan, Uludag Mehmet, Oba Sibel, Citgez Bulent, Paksoy Inci
Second Department of General Surgery, Sisli Etfal Training and Research Hospital, Sisli, Istanbul, Turkey.
JSLS. 2009 Oct-Dec;13(4):587-91. doi: 10.4293/108680809X1258998404604.
In this study, we investigated whether laparoscopic cholecystectomy, a minimally invasive procedure, is advantageous in elderly patients.
Data from 595 patients who underwent laparoscopic cholecystectomy between January 2003 and December 2007 were prospectively collected in a database. The patients were separated into 2 groups; patients >70 years of age (group A), and patients <70 years of age (group B). Group A was further divided into 3 subgroups, ages 70 to 74, 75 to 79, and 80 and above. Comparison between the groups was made with Mann-Whitney U and chi-square tests where appropriate.
ASA scores increased in conjunction with increased age (P<0.001). Of patients with an operative time longer than one hour, 26 patients aged 70 or older, and 152 patients aged 69 or younger had no difference with respect to PaCO2 and pH measurements (P>0.05). In patients aged 80 or older, the rates of acute cholecystitis, conversion to open surgery, and postoperative complications were significantly higher than in other groups (P>0.05).
We believe that in elderly patients, laparoscopic surgery can be applied safely without further increasing the surgical risks. The complications can be minimized by carefully selecting the patients aged 80 or older and by experienced teams with high technical capabilities operating on such patients.
在本研究中,我们调查了微创的腹腔镜胆囊切除术对老年患者是否具有优势。
前瞻性收集了2003年1月至2007年12月期间接受腹腔镜胆囊切除术的595例患者的数据,并录入数据库。患者被分为两组;年龄>70岁的患者(A组)和年龄<70岁的患者(B组)。A组进一步分为3个亚组,年龄分别为70至74岁、75至79岁以及80岁及以上。在适当情况下,采用Mann-Whitney U检验和卡方检验对各组进行比较。
美国麻醉医师协会(ASA)评分随年龄增长而升高(P<0.001)。手术时间超过1小时的患者中,26例70岁及以上患者与152例69岁及以下患者在PaCO2和pH测量方面无差异(P>0.05)。80岁及以上患者的急性胆囊炎发生率、转为开腹手术率和术后并发症发生率显著高于其他组(P>0.05)。
我们认为,对于老年患者,腹腔镜手术可以安全实施,而不会进一步增加手术风险。通过仔细挑选80岁及以上患者,并由技术能力高的经验丰富团队为这类患者进行手术,可以将并发症降至最低。