老年人腹腔镜胆囊切除术病例选择及围术期处理.docVIP

老年人腹腔镜胆囊切除术病例选择及围术期处理【摘要】 目的 探讨老年人腹腔镜胆囊切除术病例选择及围术期处理。方法 老年人500例行LC术，中转剖腹手术6例，行胆囊大部分切除8例，9例术中经胆囊管胆道造行。结果 全组LC手术成功率98.8%，中转剖腹手术6例，全组无死亡及严重手术并发症。结论 老年人常伴有其他慢性器官疾病，手术耐受性较差，LC围术期危险性明显增高，应严格选择手术适应证，针对不同的伴随疾病采取相应的措施，术中应相对放宽中转开腹的指征，熟练的腹腔镜外科技术等是预防和减少并发症的关键。 【关键词】老年人;腹腔镜;胆囊切除术 Case select of laparoscopic cholecystectomy and perioperative therapy in elderly MENG Yong,LIN Zheng-hai,WU Hua-tang. Department of Laparoscopic Surgery. The First Hospital of Shantou University,Shantou,515041,China 【Abstract】 Objective To discuss the case select of laparoscopic cholecystectomy(LC)andperioperative therapy in oldly people. Methods Total 500 old patients were endured LC,6 of them were converted to open surgery and 8 cases were received sectional cholecystectomy.9 cases were received operative cholangiography during cystic duct. Results The success rate of LC was 98.8%. No death in all cases and no serious complications occurs. Conclusion Because oldly people often accompany other chronic diseases, their tolerance are fairly bad, while the risk of peri-operative period is obviously raised. Strictly selecting LC indictions, treating the accompanying disease properly, broadening the indication of converting to open surgery and skilled surgeon doing the operation are key factors to prevent and reduce complications. 【Key words】Elderly; Laparoslopic; Cholecystectomy 我国人口年龄结构正发生重大变化，老年人所占人口比例逐年增高。随着手术技巧和围术期处理技术的提高，越来越多的老年人胆石症患者接受腹腔镜胆囊切除数(LC， laparoscopic cholecystectomy)治疗［1］。但随着年龄的增高，老年人重要脏器功能减退，且多伴有不同程度的慢性器官疾病，如何根据老年人的临床特点，做好LC，减少LC的并发症显的尤为重要。本文就老年人LC病例选择及围术期处理与大家探讨。 1 资料与方法 1.1 一般资料 全组500例，男164，女336，年龄60~89岁，平均66.8岁，合并心脏病27例，高血压病36例，肺部疾病伴肺功能障碍的14例，糖尿病41例，所有病例术前经B超、CT 或 ERCP 造影确诊。其中慢性胆囊炎394，急性期胆囊炎59，胆囊积液伴颈部结石嵌顿25例，胆囊萎缩22例。11例术前ERCP检查，4例胆囊未显影。平均术前准备4.9 d。术前检查发现有合并症 273 例, 约占54.6 %,其中高血压病 162 例,冠心病 19 例,心电图显示 S-T 段改变,不同程度的心肌缺血 11 例,糖尿病 65 例,慢 性支气管炎肺气肿16 例,其中两种以上合并症患者35 例。 1.2 手术方式 全麻和CO2气腹状态下行LC 500例，其中6例行胆囊大部分切除术，5例中转剖腹手术，5例术中经胆囊管胆道造影。 1.3 结果 本组无手术死亡率，无胆管损伤，6例术中