Lo C M, Lai E C, Fan S T, Liu C L, Wong J
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
World J Surg. 1996 Oct;20(8):983-6; discussion 987. doi: 10.1007/s002689900148.
This study reviewed the results of laparoscopic cholecystectomy for acute cholecystitis in the elderly. Among 557 patients who underwent laparoscopic cholecystectomy, 70 (12.6%) had a clinical diagnosis of acute cholecystitis confirmed by ultrasonography. There were 28 men and 42 women with a mean age of 59.9 years (range 20-87 years). Thirty patients >/= 65 years of age were compared to 40 patients < 65 years old. Elderly patients had a higher female predominance (p < 0.05), a higher incidence of intercurrent diseases (p < 0.05), and a higher serum urea level (p < 0.001). The proportions of patients who underwent early or delayed surgery were comparable. There was no difference in operation time, postoperative analgesic requirements, or complications. Elderly patients, however, had a significantly higher conversion rate (23.3% versus 2.5%;p < 0.05). Even after successful laparoscopic cholecystectomy, there was a longer delay before ambulation (p < 0.05) and resumption of normal diet (p = 0. 08) with resulting prolonged postoperative (p = 0.08) and total hospital stay (p < 0.05). Laparoscopic cholecystectomy is a safe, effective treatment for acute cholecystitis in the elderly. When compared to younger patients, elderly patients are at greater risk for conversion, delayed recovery, and prolonged hospital stay.
本研究回顾了老年急性胆囊炎患者行腹腔镜胆囊切除术的结果。在557例行腹腔镜胆囊切除术的患者中，70例（12.6%）经超声检查临床诊断为急性胆囊炎。其中男性28例，女性42例，平均年龄59.9岁（范围20 - 87岁）。将30例年龄≥65岁的患者与40例年龄＜65岁的患者进行比较。老年患者女性占比更高（p＜0.05），合并疾病发生率更高（p＜0.05），血清尿素水平更高（p＜0.001）。早期或延期手术患者的比例相当。手术时间、术后镇痛需求或并发症方面无差异。然而，老年患者的中转率显著更高（23.3%对2.5%；p＜0.05）。即使腹腔镜胆囊切除术成功，老年患者在术后下床活动延迟（p＜0.05）和恢复正常饮食延迟（p = 0.08），导致术后住院时间延长（p = 0.08）和总住院时间延长（p＜0.05）。腹腔镜胆囊切除术是治疗老年急性胆囊炎的一种安全、有效的方法。与年轻患者相比，老年患者中转风险更高，恢复延迟，住院时间延长。
