腹腔镜胆总管切开T管引流术在80岁以上高龄患者的应用-外科学(普通外科)专业论文.docxVIP

PAGE PAGE 10 腹腔镜胆总管切开 T 管引流术在 80 岁以上高龄患者的应用 研究生:何成周 导 师：石铮 福建医科大学附属第一医院，福州 35005 摘要 目的:探讨 80 岁以上高龄胆石症患者进行腹腔镜胆总管切开 T 管引流术的临床价 值。 方法:回顾性分析 2009 年 2 月-2013.2 月年我科连续施行腹腔镜胆总管切开 T 管 引流术的患者，选择其中≥80 岁以上 35 例作为高龄组；60 岁的 57 例作为对照 组 ，对比两组患者的基础疾病、麻醉风险、手术并发症和手术效果。 结果:1、基础疾病方面，高龄组基础疾病患病率明显高于年轻组(P0.01)，主要 表现在心血管疾病及肺部疾病方面；2、麻醉风险方面，高龄组 ASA 评分明显高 于年轻组(P0.001)；2、手术并发症方面，高龄组术后并发症发生率及等级评分 均高于年轻组（P0.05）；手术并发症发生率方面，高龄组在心脏并发症上高于 年轻组（P0.05）；手术并发症分级方面，高龄组以心脏及肺部并发症上较为严 重，达到 IVa 级。4、手术效果方面，两组病人均未出现死亡病例，两组手术成 功率、胆总管结石取尽率、自动出院率均无差别(P0.05)。 结论:虽然高龄患者麻醉风险和手术并发症发生率及等级评分较年轻组高，但做 好围手术期处理，腹腔镜胆总管切开 T 管引流术对高龄患者一样安全、有效、可 行。 关键词:高龄患者，腹腔镜胆总管切开 T 管引流术，围手术期 Laparoscopic choledocholithotomy with T-tube drainage used in elderly patients over 80 years old Abstract Objective: To evaluate the clinical value of Laparoscopic choledochotomy with T-tube drainage(LCHTD) in patients who are 80 years or older． Methods: From February 2009 to February 2013,92 patients underwent laparoscope．We divided these patients into two groups according to age and conducted a retrospective analysis ． The elderly group included patients who were 80 years old or older (n = 35) ，and the younger group included those who were younger than 60 (n = 57 )．The elderly group was compared to the younger group with respect to their basic diseases, risk of anesthesia, operation complications and operation effect． Results: 1、In the basic diseases, the elderly group show higher incidence of the basic disease(P0.01), mainly in the aspects of cardiovascular and pulmonary diseases.2、In the operation risk,the elderly group showed higher American society of Anesthesiologists score(P0.01).3、In the operation complications,the elderly group show higher rate in number and grade postoperative complications than the young group’s(P0.05)，all showed at non-abdominal complications. the elderly group show higher rate in cardiac complications than the young group’s(P0.05) ;in the elderly group, patients with heart and pulmonary complications is more serious, achi