目的

探讨腹腔镜术中应用壶腹钟表定位法和胆囊废弃术治疗80岁以上高龄急性胆囊炎临床效果及安全性。

方法

回顾性分析2015年12月至2023年9月收治的80岁以上高龄急性胆囊炎患者69例，早期腹腔镜胆囊切除（LC）组44例，遵循胆囊壶腹钟表定位法和胆囊废弃术两项安全原则施行LC；经皮经肝胆囊穿刺引流术（PTGD）序贯LC组25例，先行PTGD，1～3个月选择相对安全的窗口期施行LC。应用SPSS 22.0统计学软件处理数据，正态计量资料用(± s)表示，采用独立样本t检验；非正态计量资料采用［M（Q₁，Q₃）］表示，进行Wilcoxon秩和检验；计数资料采用［例（%）］表示，进行χ²检验。P＜0.05为差异有统计学意义。

结果

早期LC组与PTGD序贯LC组均顺利完成手术，无中转开腹，未发生胆管、十二指肠及肝右动脉损伤，也无胆漏、腹腔出血等并发症。组间比较，术中失血量、术后24 h腹腔引流量2项指标差异有统计学意义(P＜0.05)，手术时间、引流管拔除时间、肠功能恢复时间、术后平均住院日4项指标差异无统计学意义(P＞0.05)。

结论

遵循胆囊壶腹钟表定位法和胆囊废弃术两项安全原则施行LC治疗80岁以上高龄急性胆囊炎患者是安全、可行的。

Objective

To investigate the clinical effect and safety of ampulla clock localization and gallbladder abandonment in laparoscopic treatment of acute cholecystitis in patients over 80 years old.

Methods

Sixty-nine patients over 80 years old with acute cholecystitis admitted from December 2015 to September 2023 were retrospectively analyzed, and 44 patients in the early laparoscopic cholecystectomy (LC)group were performed according to the two safety principles of gallbladder ampulla horological localization and gallbladder abandonment.Percutaneous transhepatic gallbladder drainage (PTGD) sequential LC group was performed in 25 cases, PTGD was performed first, and LC was performed in a relatively safe window period of 1 to 3 months.SPSS 22.0 was used to process the data.Normal measurement data were expressed as (x±s)and independent sample t test was used.Non-normal measurement data were represented by［ M (Q₁, Q₃)］, and Wilcoxon rank sum test was performed.Counting data is represented by［ cases (%)］ and χ² test is performed.P＜0.05 was considered statistically significant.

Results

Both the early LC group and the PTGD sequential LC group successfully completed the operation, no conversion to laparotomy, no bile duct, duodenum and right hepatic artery injury, no bile leakage, abdominal hemorrhage and other complications.There were statistically significant differences in the two indexes of intraoperative blood loss and intraperitoneal drainage volume 24 h after surgery (P＜0.05), while there were no statistically significant differences in the four indexes of operation time, drainage tube removal time, intestinal function recovery time and postoperative average hospital stay (P＞0.05).

Conclusion

It is safe and feasible to perform LC in the treatment of acute cholecystitis over 80 years old by following the two safety principles of ampulla timepiece localization and gallbladder abandonment.