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目的探讨老年急性结石性胆囊炎(ACC)的手术时机,以期提高其腹腔镜手术治疗效果。方法本研究为2013年6月至2016年5月收治的79例老年ACC患者,根据其是否具有手术指征,随机分为手术组(40例)和非手术组(39例);手术组行腹腔镜胆囊切除术(LC),再根据术前发病时间早晚,分为早期LC组(<72 h)10例、晚期LC组(>72 h)30例。采用SPSS 18.0软件进行统计学处理。两组患者的血常规、高敏C反应蛋白、肝功能、血凝常规等指标以均数±标准差(x珋±s)表示,采用t检验进行比较;手术疗效以率(%)表示,组间比较采用t检验。P<0.05表示差异有统计学意义。结果术前手术组较非手术组年龄显著减小、血清总蛋白显著增高(P<0.05),两组的并存病、其余实验室检查结果均差异无统计学意义(P>0.05)。发病早期组(<72 h)与发病晚期组(>72 h)LC的手术成功率均为100%,两组的手术时间、术中出血量、术后住院天数无显著差异(P>0.05)。手术组治愈40例,治愈率100%。非手术组治愈27例,治愈率69.2%(χ2=14.512,P=0.001)差异有显著统计学意义。结论老年ACC患者既使发病时间超过72 h,腹腔镜胆囊切除术也是安全可行的,关键在于切实掌握手术时机、熟练掌握腹腔镜手术技巧,以期进一步提高老年ACC患者的腹腔镜手术治疗效果。
Objective To explore the timing of surgery in elderly patients with acute calculous cholecystitis (ACC) in order to improve the effectiveness of its laparoscopic surgery. Methods 79 elderly patients with ACC admitted to our hospital from June 2013 to May 2016 were randomly divided into operation group (n = 40) and non-operation group (n = 39) according to whether they had surgical indications. The operation group Laparoscopic cholecystectomy (LC) was divided into 10 cases of early LC group (<72 hours) and 30 cases of late LC group (> 72 hours), according to the preoperative onset time. SPSS 18.0 software was used for statistical analysis. Two groups of patients with blood, high-sensitivity C-reactive protein, liver function, blood coagulation and other indicators to mean ± standard deviation (x 珋 ± s) that the use of t test were compared; Between the t test. P <0.05 means the difference is statistically significant. Results The age of preoperative group was significantly lower than that of non - operation group, the serum total protein was significantly increased (P <0.05). There was no significant difference between the two groups in other laboratory tests (P> 0.05). The success rate of LC was 100% in early onset (<72 h) and late onset (> 72 h) LCs. There was no significant difference in operative time, intraoperative blood loss and postoperative hospital stay between the two groups (P> 0.05) . Surgical group cured 40 cases, the cure rate was 100%. In non-operation group, 27 cases were cured, the cure rate was 69.2% (χ2 = 14.512, P = 0.001), the difference was statistically significant. Conclusions The laparoscopic cholecystectomy is safe and feasible even if the onset time is over 72 hours in aged patients with ACC. The key is to grasp the timing of operation and master the skills of laparoscopic surgery in order to further improve the effect of laparoscopic surgery in aged patients with ACC.