Parra-Membrives Pablo, Martínez-Baena Darío, Lorente-Herce Jose Manuel, Jiménez-Vega Javier
*Department of Surgery, University of Seville †Hepato-bilio-pancreatic Surgery Unit, General and Digestive Surgery Department, Valme University Hospital, Sevilla, Spain.
Surg Laparosc Endosc Percutan Tech. 2014 Aug;24(4):e118-22. doi: 10.1097/SLE.0b013e31829012f6.
Although surgery is frequently not the first treatment option in elderly patients diagnosed with common bile duct stones (CBDS) because of the fear of high morbidity and mortality rates, there are few data about the safety and efficacy of laparoscopic common bile duct exploration (LCBDE) in the elderly.
From February 2004 to January 2012, 94 patients underwent LCBDE at our center. Data about sex, age, comorbidity, American Society of Anesthesiologists (ASA) score, conversion to open surgery and bile duct clearance rate, postoperative complications, need for reoperation, and mortality were analyzed comparing patients of age 70 or older (group A, n=38) with patients aged under 70 (group B, n=56).
Elderly patients had significantly more preoperative risk factors. Stone extraction was equally successful in both groups (89.5% in group A vs. 96.4% in group B, P=0.176). Six patients developed medical complications (7.9% in group A vs. 5.4% in group B, P=0.621). Surgical morbidity was equivalent for both groups (13.2% in group A vs. 10.7% in group B, P=0.718). Four patients in each group experienced some grade of bile leakage. Three patients were reoperated (1 patient in group A because of a biliary peritonitis and 2 in group B after an intra-abdominal hemorrhage). There were no mortality cases directly related to surgery.
This study reveals that LCBDE is safe in the elderly patients and results are not different from those described in the general population. Patients with choledocholithiasis should be offered to undergo an LCBDE irrespective of their age at diagnosis.
尽管由于担心高发病率和死亡率，手术通常不是诊断为胆总管结石（CBDS）的老年患者的首选治疗方案，但关于老年患者腹腔镜胆总管探查术（LCBDE）的安全性和有效性的数据很少。
2004年2月至2012年1月，94例患者在我们中心接受了LCBDE。分析了性别、年龄、合并症、美国麻醉医师协会（ASA）评分、转为开放手术情况和胆管清除率、术后并发症、再次手术需求及死亡率等数据，比较了70岁及以上患者（A组，n = 38）和70岁以下患者（B组，n = 56）。
老年患者术前危险因素明显更多。两组结石取出成功率相同（A组为89.5%，B组为96.4%，P = 0.176）。6例患者出现医疗并发症（A组为7.9%，B组为5.4%，P = 0.621）。两组手术发病率相当（A组为13.2%，B组为10.7%，P = 0.718）。每组各有4例患者出现不同程度的胆漏。3例患者接受了再次手术（A组1例因胆汁性腹膜炎，B组2例因腹腔内出血）。没有与手术直接相关的死亡病例。
本研究表明，LCBDE在老年患者中是安全的，结果与普通人群中描述的结果无差异。胆总管结石患者无论诊断时年龄多大，都应考虑接受LCBDE。
