Shin Da-Kyum, Kim Seok-Hwan, Moon Deok-Bog, Hwang Shin, Kim Ki-Hum, Ahn Chul-Soo, Ha Tae-Yong, Song Gi-Won, Jung Dong-Hwan, Song Ki-Byung, Hwang Dae-Wook, Kim Song-Cheol, Lee Young-Joo
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Chungnam National University Hospital, Chungnam National University of College of Medicine, Daejeon, Korea.
Ann Hepatobiliary Pancreat Surg. 2018 Nov;22(4):380-385. doi: 10.14701/ahbps.2018.22.4.380. Epub 2018 Nov 27.
BACKGROUNDS/AIMS: Elderly patients aged >80 yr have high morbidity and mortality rates after biliary surgery, especially in emergency operations. We conducted this study to determine the effect of preoperative management on the outcome of elderly patients undergoing cholecystectomy.
The medical records of 452 elderly (≥80 yr old) patients who underwent cholecystectomy from January 1997 to December 2015 were reviewed retrospectively. We divided the patients into 2 groups: intervention (preoperative biliary drainage) and non-intervention groups. We evaluated the effects of preoperative management on the American Society of Anesthesiology (ASA) score and perioperative outcomes.
Among the preoperative biliary drainage intervention group (n=286), 48 patients (51.7%) were diagnosed as having gallbladder stone combined with common bile duct stone. On admission, the proportion of patients with ASA score ≥3 and WBC counts were significantly higher in the intervention group than in the non-intervention group (<0.05). The preoperative hospital stay was longer in the intervention group; however, operation-related factors such as operation type, time, conversion rate, complications, and mortality showed no difference between groups.
With proper preoperative evaluations and preoperative biliary drainage, cholecystectomy can be a safe treatment option for elderly patients with cholelithiasis.
背景/目的：80岁以上老年患者行胆道手术后发病率和死亡率较高，尤其是急诊手术。我们开展本研究以确定术前管理对老年胆囊切除术患者结局的影响。
回顾性分析1997年1月至2015年12月期间接受胆囊切除术的452例老年（≥80岁）患者的病历。我们将患者分为两组：干预组（术前胆道引流）和非干预组。我们评估了术前管理对美国麻醉医师协会（ASA）评分和围手术期结局的影响。
在术前胆道引流干预组（n = 286）中，48例患者（51.7%）被诊断为胆囊结石合并胆总管结石。入院时，干预组ASA评分≥3分和白细胞计数的患者比例显著高于非干预组（<0.05）。干预组术前住院时间更长；然而，手术类型、时间、中转率、并发症和死亡率等手术相关因素在两组之间无差异。
通过适当的术前评估和术前胆道引流，胆囊切除术对于老年胆石症患者可以是一种安全的治疗选择。
