Sato Manabu, Endo Koujin, Harada Akihiko, Yabuuchi Shinichi
Department of Surgery, Sendai South Hospital.
Nihon Shokakibyo Gakkai Zasshi. 2017;114(9):1649-1657. doi: 10.11405/nisshoshi.114.1649.
Laparoscopic cholecystectomy (LC) is performed for gallbladder stones and cholecystitis in a large number of elderly patients. However, the safety of LC in the elderly is questioned. The aim of this study was to investigate predictive factors for the incidence of postoperative complications and deaths after LC in patients aged 80 years and older. Data from 85 elderly patients who underwent LC between January 2005 and December 2015 were prospectively collected in a database at our hospital. The following factors were compared for the occurrence of postoperative complications and deaths:age, gender, Body Mass Index, laboratory date, severity grade of cholecystitis, comorbidity of choledocholithiasis, conversion to open cholecystectomy, early or delayed LC, amount of time from onset to LC, operative duration, blood loss, and the following scoring systems for predicting risk of surgery:ECOG-PS, ASA, SIRS, CONUT, POSSUM, SAS, E-PASS. The complication rate of LC was 14.1% in this cohort. WBC, CRP, BUN, Cre, Na, PT-INR, severity of cholecystitis, conversion to open cholecystectomy, operative duration, early LC, ASA, SIRS, CONUT, POSSUM (PS, OS, complication rate), SAS, E-PASS (PRS, SSS, CRS) showed significant variability in univariate analysis. A high POSSUM score of complication and moderate or severe cholecystitis were independent risk factors for postoperative complication. Analysis of the ROC showed that the best cut-off point for the POSSUM score of complication was 51.5. LC for gallbladder stones and cholecystitis in elderly is a reliable operation, but the procedure for cases with a high score of the POSSUM for complications, or moderate or severe cholecystitis, may have the risk of postoperative complications in elderly patients.
腹腔镜胆囊切除术（LC）用于大量老年患者的胆囊结石和胆囊炎治疗。然而，LC在老年患者中的安全性受到质疑。本研究旨在调查80岁及以上患者LC术后并发症发生率和死亡率的预测因素。2005年1月至2015年12月期间在我院接受LC的85例老年患者的数据被前瞻性地收集到数据库中。比较以下因素与术后并发症和死亡的发生情况：年龄、性别、体重指数、实验室数据、胆囊炎严重程度分级、胆总管结石合并症、转为开腹胆囊切除术、早期或延迟LC、发病至LC的时间、手术持续时间、失血量，以及以下预测手术风险的评分系统：ECOG-PS、ASA、SIRS、CONUT、POSSUM、SAS、E-PASS。该队列中LC的并发症发生率为14.1%。白细胞、CRP、BUN、Cre、Na、PT-INR、胆囊炎严重程度、转为开腹胆囊切除术、手术持续时间、早期LC、ASA、SIRS、CONUT、POSSUM（PS、OS、并发症发生率）、SAS、E-PASS（PRS、SSS、CRS）在单因素分析中显示出显著差异。高并发症POSSUM评分和中度或重度胆囊炎是术后并发症的独立危险因素。ROC分析显示，并发症POSSUM评分的最佳切点为51.5。老年患者因胆囊结石和胆囊炎行LC是一种可靠的手术，但对于并发症POSSUM评分高或中度或重度胆囊炎的病例，手术可能有术后并发症的风险。
