Ambe Peter C, Weber Sebastian A, Christ Hildegard, Wassenberg Dirk
Department of Surgery II, Helios Klinikum Wuppertal, Witten/Herdecke University, Heusner Str. 40, 42283, Wuppertal, Germany.
Department of General, Visceral and Thoracic Surgery, St. Remigius Hospital Opladen, An St. Remigius 26, 51379, Leverkusen, Germany.
Aging Clin Exp Res. 2015 Dec;27(6):921-6. doi: 10.1007/s40520-015-0361-0. Epub 2015 Apr 24.
While early cholecystectomy is generally accepted as the standard procedure for young and fit patients with acute cholecystitis, controversy exits on the management of elderly and severely sick patients. We postulated that primary cholecystectomy is feasible in this subgroup. The aim of this study was to compare the outcomes of young and fit patients to those of elderly patients undergoing surgery for acute cholecystitis.
The outcomes of elderly patients (≥70 years) undergoing surgery for acute cholecystitis in a primary care center in Germany were retrospectively compared to those of younger patients (<70 years).
152 patients, 74 aged ≥ 70 years (study group) and 78 < 70 years (control) were included for analysis. The study group was significantly older at the time of surgery (78 vs. 68 years, p = 0.02). Severe cholecystitis was seen in a significant number of cases in the study group, p = 0.01. Equally, the mean WBC (19.5 vs. 17, p = 0.02), CRP (26 vs. 22, p = 0.04) and APACHE II score (17 vs. 8, p = 0.01) were significantly higher in the study group. There was no significant difference in the duration of anesthesia (123 vs. 133 min, p = 0.70) and surgery (72 vs. 81 min, p = 0.90) amongst both groups. There was no significant difference in rate of complication amongst both groups (24 vs. 14%, p = 0.11). Two cases of mortality were recorded (1.3%) in the study group.
The age of the patient cannot be the sole factor in deciding whether or not a patient with acute cholecystitis is fit for surgery.
虽然早期胆囊切除术通常被认为是年轻且健康的急性胆囊炎患者的标准治疗方法，但对于老年和重症患者的治疗仍存在争议。我们推测在这一亚组患者中行一期胆囊切除术是可行的。本研究的目的是比较年轻且健康的急性胆囊炎手术患者与老年患者的治疗结果。
回顾性比较德国一家初级保健中心中接受急性胆囊炎手术的老年患者（≥70岁）与年轻患者（<70岁）的治疗结果。
共纳入152例患者进行分析，其中74例年龄≥70岁（研究组），78例<70岁（对照组）。研究组患者手术时年龄显著更大（78岁对68岁，p = 0.02）。研究组中相当数量的病例存在重症胆囊炎，p = 0.01。同样，研究组患者的平均白细胞计数（19.5对17，p = 0.02）、C反应蛋白（26对22，p = 0.04）和急性生理与慢性健康状况评分系统II（APACHE II）评分（17对8，p = 0.01）均显著更高。两组间麻醉时间（123分钟对133分钟，p = 0.70）和手术时间（72分钟对81分钟，p = 0.90）无显著差异。两组间并发症发生率无显著差异（24%对14%，p = 0.11）。研究组记录到2例死亡病例（1.3%）。
患者年龄不能作为决定急性胆囊炎患者是否适合手术的唯一因素。
