Feldman M G, Russell J C, Lynch J T, Mattie A
St. Vincent Hospital, Bridgeport, Connecticut.
J Laparoendosc Surg. 1994 Jun;4(3):165-72. doi: 10.1089/lps.1994.4.165.
The objective was to determine the safety of laparoscopic cholecystectomy for patients 65 years of age and older with symptomatic uncomplicated chronic gallbladder disease by comparing the mortality rate with open cholecystectomy. Connecticut Hospital Information Management Exchange and the Connecticut Society of American Board of Surgeons established a Connecticut Laparoscopic Registry made up of 33 acute care hospitals. A cohort longitudinal retrospective statewide registry collected data mortality rates on all 2865 elderly patients undergoing open (OC) or closed (LC) cholecystectomy for uncomplicated chronic cholecystitis. A database was established and continuously monitored from October 1, 1988, to December 31, 1992. Seven hundred sixty-one patients over 65 years of age underwent open cholecystectomy for uncomplicated chronic cholecystectomy during fiscal year 1989, with a mortality rate of 1.4%. The mortality rate of a similar cohort of patients who underwent laparoscopic cholecystectomy during fiscal years 1991 and 1992 was 0.3% and 0.6%, respectively. The mortality rate was further broken down into age subsets 65-69, 70-79, and 80+. The prelaparoscopic era (FY 1989) age subsets were compared with those of the laparoscopic era (FY 1991 and 1992). A statistically significant reduction (p = 0.01) in mortality rate was noted in the 70-79 age group following laparoscopic surgery. Laparoscopic cholecystectomy in the elderly for the treatment of symptomatic, uncomplicated chronic cholecystitis is as safe if not safer than open cholecystectomy as measured by mortality rate.
目的是通过比较腹腔镜胆囊切除术与开腹胆囊切除术的死亡率，来确定65岁及以上有症状的非复杂性慢性胆囊疾病患者进行腹腔镜胆囊切除术的安全性。康涅狄格医院信息管理交换中心和康涅狄格美国外科医师委员会建立了一个由33家急症护理医院组成的康涅狄格腹腔镜注册中心。一个队列纵向回顾性全州注册中心收集了所有2865例因非复杂性慢性胆囊炎接受开腹（OC）或腹腔镜（LC）胆囊切除术的老年患者的死亡率数据。建立了一个数据库，并从1988年10月1日至1992年12月31日持续监测。1989财政年度，761例65岁以上患者因非复杂性慢性胆囊炎接受了开腹胆囊切除术，死亡率为1.4%。1991年和1992年财政年度，类似队列的患者接受腹腔镜胆囊切除术的死亡率分别为0.3%和0.6%。死亡率进一步细分为65 - 69岁、70 - 79岁和80岁以上年龄组。将腹腔镜手术前时代（1989财政年度）的年龄组与腹腔镜时代（1991年和1992年财政年度）的年龄组进行比较。腹腔镜手术后，70 - 79岁年龄组的死亡率有统计学显著降低（p = 0.01）。从死亡率衡量，老年患者进行腹腔镜胆囊切除术治疗有症状的非复杂性慢性胆囊炎即使不比开腹胆囊切除术更安全，至少也是同样安全的。
