65岁以上胆道疾病患者日间腹腔镜胆囊切除的安全性分析

曹俊宁; 赵森峰; 李向军; 刘博

doi:10.3969/j.issn.1001-5256.2017.05.020

65岁以上胆道疾病患者日间腹腔镜胆囊切除的安全性分析

DOI: 10.3969/j.issn.1001-5256.2017.05.020

中国人民解放军总医院肝胆外科

详细信息

中图分类号: R657.4
计量
- 文章访问数: 2587
- HTML全文浏览量: 62
- PDF下载量: 428
- 被引次数: 0
出版历程
- 出版日期: 2017-05-20

A safety analysis of day-surgery laparoscopic cholecystectomy for elderly patients aged above 65 years with biliary tract diseases

Department of Hepatobiliary Surgery, PLA General Hospital

摘要

摘要:
目的探讨老年患者日间手术腹腔镜胆囊切除（LC/DS）的安全性。方法收集2009年11月-2015年7月于中国人民解放军总医院行LC/DS的4764例患者的临床资料。分析其中老年患者（≥65岁）的一般信息、手术时间、术中出血量、术后住院日、满意率、延迟出院原因、因心理因素延迟出院率、留置腹腔引流管延迟出院率、并发症发生率、中转开腹率、出院30 d内再入院率、病死率等,并与非老年患者（≤64岁）进行比较。非正态分布的计量资料2组间比较采用Mann-Whitney U检验;计数资料2组间比较采用χ2检验。结果 710例老年患者与4054例非老年患者接受LC/DS,病死率为0。老年患者与非老年患者的手术时间[57.5（41.874.3）min vs 54.0（40.070.0）min,Z=-2.715,P=0.007]、术中出血量[10.0（5.020.0）ml vs 5.0（010.0）ml,Z=-8.604,P<0.001]、术后住院时间[1.0（1.01
- 胆囊切除术,腹腔镜 /
- 日间住院医疗 /
- 老年人
Abstract:
Objective To investigate the safety of day-surgery laparoscopic cholecystectomy (LC/DS) in elderly patients.Methods The clinical data were collected from 4764 patients who underwent LC/DS in PLA General Hospital from November 2009 to July 2015, and a retrospective analysis was performed for the general data, time of operation, intraoperative blood loss, length of postoperative hospital stay, satisfaction rate, reason for delayed discharge, rate of delayed discharge caused by psychological factors, rate of delayed discharge caused by abdominal drainage tube placement, incidence of complications, rate of conversion to laparotomy, readmission rate with 30 days after discharge, and mortality rate of elderly patients (≥65 years) .The clinical data of elderly patients were compared with those of non-elderly patients.The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.Results A total of 710 elderly patients and 4054 non-elderly patients underwent LC/DS, and no patients died.There were significant differences between these two groups in the time of operation [57.5 (41.8-74.3) min vs 54.0 (40.0-70.0) min, Z=-2.715, P=0.007], intraoperative blood loss [10.0 (5.0-20.0) ml vs 5.0 (0-10.0) ml, Z=-8.604, P<0.001], length of postoperative hospital stay [1.0 (1.0-1.0) d vs 1.0 (1.0-1.0) d, Z=-3.778, P<0.001], overall rate of delayed discharge (20.3% vs 14.8%, χ2=13.637, P<0.001) , rate of delayed discharge caused by psychosocial factors (8.6% vs 6.5%, χ2=4.220, P=0.040) , and rate of delayed discharge caused by abdominal drainage tube placement (4.4% vs 2.0%, χ2=13.909, P<0.001) .There were no significant differences between the two groups in the incidence of complications (6.5% vs 5.9%, χ2=0.334, P=0.563) , rate of conversion to laparotomy (0.8% vs 0.4%, χ2=2.119, P=0.145) , and readmission rate within 30 days after discharge (0.7% vs 0.5%, χ2=0.190, P=0.663) .Conclusion Elderly patients undergoing LC/DS have comparable risks of complications, conversion to laparotomy, and readmission to non-elderly patients, which suggests that LC/DS is safe and feasible.
- cholecystectomy, laparoscopic /
- day care /
- aged

HTML全文

参考文献(23)

[1]PLANELLS RM, GARCIA ER, CERVERA DM, et al.Ambulatory laparoscopic cholecystectomy.A cohort study of 1, 600 consecutive cases[J].Cir Esp, 2013, 91 (3) :156-162.

[2]SATO A, TERASHITA Y, MORI Y, et al.Ambulatory laparoscopic cholecystectomy:an audit of day case vs overnight surgery at a community hospital in Japan[J].World J Gastrointest Surg, 2012, 4 (12) :296-300.

[3]VICTORZON M, TOLONEN P, VUORIALHO T, et al.Day-case laparoscopic cholecystectomy:treatment of choice for selected patients[J].Surg Endosc, 2007, 21 (1) :70-73.

[4]KRAFT K, MARIETTE C, SAUVANET A, et al.Indications for ambulatory gastrointestinal and endocrine surgery in adults[J].JVisc Surg, 2011, 148 (1) :69-74.

[5] LIU B, LI CG, CHEN JY, et al.The analysis of 1240 cases of laparoscopic cholecystectomy performed during the day time[J].J Clin Hepatol, 2011, 27 (9) :912-915. (in Chinese) 刘博, 李成刚, 陈继业, 等.日间手术腹腔镜胆囊切除1240例分析[J].临床肝胆病杂志, 2011, 27 (9) :912-915.

[6]BRIGGS CD, IRVING GB, MANN CD, et al.Introduction of a day-case laparoscopic cholecystectomy service in the UK:a critical analysis of factors influencing same-day discharge and contact with primary care providers[J].Ann R Coll Surg Engl, 2009, 91 (7) :583-590.

[7]WEBER DM.Laparoscopic surgery:an excellent approach in elderly patients[J].Arch Surg, 2003, 138 (10) :1083-1088.

[8]PSAILA J, AGRAWAL S, FOUNTAIN U, et al.Day-surgery laparoscopic cholecystectomy:factors influencing same-day discharge[J].World J Surg, 2008, 32 (1) :76-81.

[9]CHANG SK, TAN WB.Feasibility and safety of day surgery laparoscopic cholecystectomy in a university hospital using a standard clinical pathway[J].Singapore Med J, 2008, 49 (5) :397-399.

[10]BRESCIA A, GASPARRINI M, NIGRI G, et al.Laparoscopic cholecystectomy in day surgery:feasibility and outcomes of the first 400 patients[J].Surgeon, 2013, 11 (Suppl 1) :s14-s18.

[11]RAO A, POLANCO A, QIU S, et al.Safety of outpatient laparoscopic cholecystectomy in the elderly:analysis of 15, 248 patients using the NSQIP database[J].J Am Coll Surg, 2013, 217 (6) :1038-1043.

[12]LLEDO JB, PLANELLS M, ESPI A, et al.Predictive model of failure of outpatient laparoscopic cholecystectomy[J].Surg Laparosc Endosc Percutan Tech, 2008, 18 (3) :248-253.

[13]LEZANA PM, CARREO VG, LORA CP, et al.Comparative study of ambulatory laparoscopic cholecystectomy versus management of laparoscopic cholecystectomy with conventional hospital stay[J].Cir Esp, 2013, 91 (7) :424-431.

[14]AKOH JA, WATSON WA, BOURNE TP.Day case laparoscopic cholecystectomy:reducing the admission rate[J].Int J Surg, 2011, 9 (1) :63-67.

[15]CANTORE F, BONI L, DI GM, et al.Pre-incision local infiltration with levobupivacaine reduces pain and analgesic consumption after laparoscopic cholecystectomy:a new device for day-case procedure[J].Int J Surg, 2008, 6 (Suppl 1) :s89-s92.

[16]LAU H, BROOKS DC.Contemporary outcomes of ambulatory laparoscopic cholecystectomy in a major teaching hospital[J].World JSurg, 2002, 26 (9) :1117-1121.

[17]CHOK KS, YUEN WK, LAU H, et al.Outpatient laparoscopic cholecystectomy in Hong Kong Chinese---an outcome analysis[J].Asian J Surg, 2004, 27 (4) :313-316.

[18]MJALAND O, RAEDER J, AASBOE V, et al.Outpatient laparoscopic cholecystectomy[J].Br J Surg, 1997, 84 (7) :958-961.

[19]HAZZAN D, GERON N, GOLIJANIN D, et al.Laparoscopic cholecystectomy in octogenarians[J].Surg Endosc, 2003, 17 (5) :773-776.

[20]FUKS D, COSSE C, SABBAGH C, et al.Can we consider daycase laparoscopic cholecystectomy for acute calculous cholecystitis?Identification of potentially eligible patients[J].J Surg Res, 2014, 186 (1) :142-149.

[21]Association of Anaesthetists of Great Britain and Ireland;British Association of Day surgery.Day case and short stay surgery:2[J].Anaesthesia, 2011, 66 (5) :417-434.

[22]SENECA M, ZAPP M, SENECA M.Perioperative changes in oxygen saturation after ambulatory laparoscopic cholecystectomy:a retrospective analysis[J].AANA J, 2013, 81 (4) :292-296.

[23]TOPAL B, PEETERS G, VERBERT A, et al.Outpatient laparoscopic cholecystectomy:clinical pathway implementation is efficient and cost effective and increases hospital bed capacity[J].Surg Endosc, 2007, 21 (7) :1142-1146.

施引文献

资源附件(0)

访问统计