[老年患者急性胆囊炎的腹腔镜胆囊切除术结果]

[Results of laparoscopic cholecystectomy for acute cholecystitis in elderly patients].

作者信息

Lucidarme D, Corman N, Courtade A, Atat I, Forzy G, Filoche B, Desrousseaux B

机构信息

Département Médico-Chirurgical d'Hépato-Gastroentérologie, C.H. Saint Philibert, Lomme.

出版信息

J Chir (Paris). 1997 Dec;134(7-8):291-5.

PMID:9772992

Abstract

OBJECTIVES

The aim of this retrospective study was to evaluate the feasibility and the morbidity of laparoscopic cholecystectomy for acute cholecystitis in elderly patients.

METHODS

Among 891 consecutive patients who underwent cholecystectomy, 151 had acute cholecystitis. Fifty three patients of > or = 70 years of age (group 1) were compared to 98 younger patients (group 2). Analysis was made in "intention to treat" so directly open cholecystectomies during the same period were also included.

RESULTS

Elderly patients had a lower success rate of laparoscopic treatment (52.8% versus 70.4%; p < 0.05). This difference was due to higher rate of directly open cholecystectomy in the elderly (17% versus 2%). There was no difference between both groups in conversion rate to laparotomy (30.2% versus 26.5%). Surgical morbidity was 7.5% in group 1 and 4% in group 2 (NS). General complications were more frequent in the elderly (p < 0.05). Five patients in group 1 (9.4%) died of general complications of which 3 were operated on directly by open cholecystectomy. There was no mortality in group 2.

CONCLUSION

Acute cholecystitis in the elderly remains a severe disease in which laparoscopic treatment is only possible in about fifty percent.

摘要

目的

本回顾性研究旨在评估老年患者急性胆囊炎行腹腔镜胆囊切除术的可行性及发病率。

方法

在891例连续接受胆囊切除术的患者中，151例患有急性胆囊炎。将53例年龄≥70岁的患者（第1组）与98例年轻患者（第2组）进行比较。分析采用“意向性治疗”，因此同期直接行开腹胆囊切除术的患者也纳入其中。

结果

老年患者腹腔镜治疗成功率较低（52.8%对70.4%；p<0.05）。这种差异是由于老年患者直接行开腹胆囊切除术的比例较高（17%对2%）。两组中转开腹率无差异（30.2%对26.5%）。第1组手术发病率为7.5%，第2组为4%（无统计学意义）。老年患者全身并发症更常见（p<0.05）。第1组有5例患者（9.4%）死于全身并发症，其中3例直接行开腹胆囊切除术。第2组无死亡病例。