Saxe A, Lawson J, Phillips E
Department of Surgery, Sinai Hospital, Detroit, MI.
J Laparoendosc Surg. 1993 Jun;3(3):215-9. doi: 10.1089/lps.1993.3.215.
Laparoscopic cholecystectomy is replacing open cholecystectomy in the surgical management of gallstone disease in healthy individuals. However, the role of laparoscopic cholecystectomy in patients thought to be at higher risk for surgical morbidity is still being defined. The course of patients aged 65 or greater who underwent attempted and successful laparoscopic cholecystectomies were reviewed. Eleven patients (12%) were converted from laparoscopic to open cholecystectomy. For the 83 patients completing laparoscopic cholecystectomy, the median time of surgery was 115 min and the median length of postoperative stay was 1 day. Two patients required parenteral analgesia longer than 48 h. Seven patients were admitted and monitored postoperatively, although five of these were preoperatively planned. Five patients were readmitted within 30 days. One patient was admitted with a myocardial infarction, one a subphrenic abscess, one an incarcerated hernia, one with pyrexia and leukocytosis (for which no source was identified), and one for an elective urinary tract procedure. Laparoscopic cholecystectomy provides patients aged 65 or older the same benefits of shorter hospital stay and less pain than it provides younger patients. Age alone should not be a contraindication to attempted laparoscopic cholecystectomy.
在健康个体的胆结石疾病手术治疗中，腹腔镜胆囊切除术正在取代开腹胆囊切除术。然而，腹腔镜胆囊切除术在被认为手术并发症风险较高的患者中的作用仍有待明确。我们回顾了65岁及以上接受腹腔镜胆囊切除术且手术尝试成功的患者的病程。11例患者（12%）由腹腔镜胆囊切除术转为开腹胆囊切除术。对于83例完成腹腔镜胆囊切除术的患者，手术中位时间为115分钟，术后中位住院时间为1天。2例患者需要超过48小时的胃肠外镇痛。7例患者术后入院并接受监测，尽管其中5例是术前计划好的。5例患者在30天内再次入院。1例患者因心肌梗死入院，1例因膈下脓肿入院，1例因嵌顿疝入院，1例因发热和白细胞增多（未发现病因）入院，1例因择期泌尿系统手术入院。腹腔镜胆囊切除术为65岁及以上患者带来了与年轻患者相同的好处，即住院时间更短、疼痛更少。仅年龄不应成为尝试腹腔镜胆囊切除术的禁忌证。
