Zheng Chufa, Huang Yaokui, Xie E, Xie Dejin, Peng Yunheng, Wang Xiaozhong
Department of General Surgery, the Affiliated Shantou Hospital of Sun Yat-sen University, Guangdong, 515000, China.
Surg Endosc. 2017 Jun;31(6):2541-2547. doi: 10.1007/s00464-016-5257-3. Epub 2016 Dec 23.
Common bile duct (CBD) stone is one of the most common diseases among elderly people. In recent decades, there are numerous studies regarding the safety and efficacy of laparoscopic common bile duct exploration (LCBDE). Elderly patients are often regarded as high-risk patients because they are more likely to present with age-specific deterioration of organ function and coexisting chronic diseases, which may reduce their tolerance of laparoscopic surgery. Although laparoscopic surgery for choledocholithiasis is now widely accepted as the treatment for CBD stone, its appropriateness for the treatment of elderly patients or those with coexisting high-risk patients has not been well established. Therefore, the objective of this paper is to analyze the safety and efficacy of LCBDE in elderly patients.
Between January 2012 and November 2015, 376 patients underwent LCBDE in our center. Based on their ages, they were divided into two groups, and a retrospective study was performed. By making comparisons between younger group who were younger than 70 years (n = 253) and elderly group who were 70 years old or older (n = 123), the demographics, clinical characteristics, laboratory data, operative parameters and outcomes were analyzed.
Before operation, elderly patients had more coexisting chronic diseases and risk factors, such as arterial hypertension, heart diseases, pulmonary diseases and previous abdominal surgery (P < 0.05). In both groups, LCBDE was equally successful with a high clearance rate (100 % in elderly patients vs. 98.8 % in younger group, P = 0.554). Besides, the operating time, intraoperative blood loss, postoperative hospital stay, total costs and overall complication showed no significant difference between two groups (P > 0.05). There was no major bile duct injury or death in either group.
Although elderly patients are frequently confronted with coexisting disorders, LCBDE can be considered as a safe and effective technique in choledocholithiasis treatment for elderly patients.
胆总管结石是老年人中最常见的疾病之一。近几十年来，有许多关于腹腔镜胆总管探查术（LCBDE）安全性和有效性的研究。老年患者常被视为高危患者，因为他们更易出现器官功能随年龄增长而衰退以及并存慢性疾病，这可能降低他们对腹腔镜手术的耐受性。尽管现在腹腔镜胆总管结石手术已被广泛接受为胆总管结石的治疗方法，但其对老年患者或并存高危情况患者治疗的适用性尚未得到充分证实。因此，本文的目的是分析LCBDE在老年患者中的安全性和有效性。
2012年1月至2015年11月期间，376例患者在本中心接受了LCBDE。根据年龄将他们分为两组，并进行回顾性研究。通过比较年龄小于70岁的较年轻组（n = 253）和70岁及以上的老年组（n = 123），分析了人口统计学、临床特征、实验室数据、手术参数和结果。
术前，老年患者并存更多慢性疾病和危险因素，如动脉高血压、心脏病、肺部疾病和既往腹部手术史（P < 0.05）。两组中，LCBDE均同样成功，清除率高（老年患者为100%，较年轻组为98.8%，P = 0.554）。此外，两组之间的手术时间、术中出血量、术后住院时间、总费用和总体并发症无显著差异（P > 0.05）。两组均未发生重大胆管损伤或死亡。
尽管老年患者常并存多种疾病，但LCBDE可被视为治疗老年患者胆总管结石的一种安全有效的技术。
