Behrman S W, Melvin W S, Babb M E, Johnson J, Ellison E C
Department of Surgery, Grant Medical Center, Columbus, Ohio, USA.
Am Surg. 1996 May;62(5):386-90.
Although the role of laparoscopic cholecystectomy (LC) as a safe and cost effective procedure has been ascertained, its role in the geriatric population, the majority of whom present with coexistent diseases, has yet to be defined. We retrospectively reviewed outcome parameters of 144 consecutive patients over age 65 undergoing LC, for both acute cholecystitis and symptomatic cholelithiasis. These results were compared with 72 patients having open cholecystectomy (OC) during the same time period and in the year preceding the introduction of LC. Groups were well matched with respect to age, age distribution indication for surgery, and underlying comorbid illnesses. Of those with symptomatic cholelithiasis, LC did not prolong operative time when compared with OC, but resulted in significantly earlier discharge (1.8 +/- 2.9 vs. 6.7 +/- 5.7 days (P < 0.0001)), with comparable hospital costs and with no increase in postoperative complications. With respect to acute cholecystitis, LC significantly prolonged operative time (105.8 +/- 40.8 vs. 78.1 +/- 28.5 minutes (P < 0.05)), but when successful, significantly reduced postoperative stay (4.2 +/- 3.8 vs. 7.5 +/- 2.3 days (P < 0.05)). There was no increase in postoperative complications in those having LC, and hospital costs were comparable with OC. Seven patients were converted from LC to OC; 4 of these (16%) were for acute cholecystitis versus a 2.5 per cent incidence of conversion for symptomatic cholelithiasis, and these resulted in prolonged hospital stays and costs. There was no incidence of hypotension/hypercarbia, despite a 64 per cent incidence of cardiopulmonary cardiopulmonary diseases in those having LC. There was a 14 per cent incidence of cardiopulmonary complications in those having LC in contrast to a 43 per cent incidence in OC. LC in the geriatric population is a safe procedure for symptomatic cholelithiasis. The procedure should be undertaken with caution in those with acute cholecystitis with a low threshold for either early conversion or primary OC. Finally, our results suggest that extensive hemodynamic monitoring is not indicated.
尽管腹腔镜胆囊切除术（LC）作为一种安全且具有成本效益的手术方式已得到确认，但其在老年人群中的作用尚未明确，而大多数老年患者都伴有多种并存疾病。我们回顾性分析了144例年龄在65岁以上因急性胆囊炎和有症状胆结石接受LC手术患者的预后参数。将这些结果与同期以及引入LC手术前一年进行开腹胆囊切除术（OC）的72例患者进行比较。两组患者在年龄、年龄分布、手术指征以及潜在合并疾病方面匹配良好。对于有症状胆结石患者，与OC相比，LC并未延长手术时间，但出院时间显著提前（1.8±2.9天对6.7±5.7天（P<0.0001）），住院费用相当，且术后并发症未增加。对于急性胆囊炎患者，LC显著延长了手术时间（105.8±40.8分钟对78.1±28.5分钟（P<0.05）），但手术成功后，术后住院时间显著缩短（4.2±3.8天对7.5±2.3天（P<0.05））。接受LC手术的患者术后并发症未增加，住院费用与OC相当。7例患者由LC转为OC；其中4例（16%）因急性胆囊炎转为OC，而有症状胆结石患者的中转率为2.5%，中转导致住院时间延长和费用增加。尽管接受LC手术的患者中心肺疾病发生率为64%，但未发生低血压/高碳酸血症。接受LC手术的患者中心肺并发症发生率为14%，而OC患者中这一发生率为43%。对于有症状胆结石的老年患者，LC是一种安全的手术方式。对于急性胆囊炎患者，应谨慎进行LC手术，早期中转或直接行OC的阈值应较低。最后，我们的结果表明无需进行广泛的血流动力学监测。
