Cui Wei, Zhang Ru-Yuan, Sun Deng-Qun, Gong Ren-Hua, Han Tian-Quan
Department of Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Surgery, 200025 Shanghai, China.
Hepatogastroenterology. 2010 May-Jun;57(99-100):409-13.
BACKGROUND/AIMS: Evidence now strongly supports that early laparoscopic cholecystectomy (ELC) is the treatment of choice for acute gallbladder disease. However, the optimal time for managing acute gallbladder disease in elderly people is still controversial. The purpose of this study was to evaluate the outcome of ELC in patients aged 65 years old and older.
We performed a retrospective case study review of patients undergoing ELC in a single institution between January 2005 and December 2008.
A total of 4048 patients were analyzed: 737 patients were older than 65 years old and 3311 younger. In total, 18% of the elderly patients and 3% of the younger patients had American Society of Anesthesiologists (ASA) score III and IV, respectively (p < 0.001). Co-morbidity rates were significantly higher in the elderly group (61.5% vs. 20.7%, p < 0.001). There was no difference in operative time, intraoperative complications, hospital stay and mortality between the two groups, except that the rate of conversion to open cholecystectomy (OC) and postoperative complications were significantly higher in elderly patients.
Even though elderly patients are more likely to present with several co-morbidities in advanced stages, ELC for elderly patients with acute gallbladder disease is safe and effective, and should be regarded as the standard of care.
背景/目的：目前有充分证据支持早期腹腔镜胆囊切除术（ELC）是急性胆囊疾病的首选治疗方法。然而，老年人急性胆囊疾病的最佳治疗时机仍存在争议。本研究的目的是评估65岁及以上患者行ELC的疗效。
我们对2005年1月至2008年12月在单一机构接受ELC的患者进行了回顾性病例研究。
共分析了4048例患者：737例年龄大于65岁，3311例年龄较小。总体而言，18%的老年患者和3%的年轻患者美国麻醉医师协会（ASA）评分为III级和IV级，分别（p < 0.001）。老年组的合并症发生率显著更高（61.5%对20.7%，p < 0.001）。两组之间的手术时间、术中并发症、住院时间和死亡率无差异，只是老年患者中转开腹胆囊切除术（OC）的发生率和术后并发症显著更高。
尽管老年患者更可能在晚期出现多种合并症，但老年急性胆囊疾病患者行ELC是安全有效的，应被视为标准治疗方法。
