Acute cholecystitis over 80 years old was treated with ampulla horological localization and gallbladder abandonment in laparoscopic surgery

doi:10.3877/cma.j.issn.1674-3946.2025.02.019.

Abstract

Abstract:

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.

Key words: Cholecystitis,Acute, Cholecystectomy,Laparoscopic, Gallbladder Infundibulum Clock Positioning Method, Gallbladder Disabled Technique, Percutaneous Transhepatic Gallbladder Drainage

Wei Zhang, Dandan Shang, Peizhong Shang, Xiaowu Li, Jianjun Miao, Bing Liu. Acute cholecystitis over 80 years old was treated with ampulla horological localization and gallbladder abandonment in laparoscopic surgery[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(02): 188-191.

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Figures/Tables 2

组别	例数	男/女（例）	年龄［岁，M（Q₁，Q₃)］	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）
早期LC组	44	34/10	82.0（80.0，85.0）	21.8±3.4
PTGD序贯LC组	25	17/8	82.0（80.0，83.5）	21.7±3.9
χ ²/Z/t值		0.711	0.369	0.111
P值		0.399	0.712	0.455
组别	例数	胆囊长径（cm， $\overset{ˉ}{x}$ ±s）	胆囊壁厚度（mm， $\overset{ˉ}{x}$ ±s）	ASA分级（例）
组别	例数	胆囊长径（cm， $\overset{ˉ}{x}$ ±s）	胆囊壁厚度（mm， $\overset{ˉ}{x}$ ±s）	Ⅰ级/Ⅱ级/Ⅲ级
早期LC组	44	9.3±3.9	5.3±1.9	5/31/8
PTGD序贯LC组	25	9.8±2.2	5.8±1.8	3/17/5
χ ²/Z/t值		-0.589	-1.070	0.047
P值		0.279	0.144	0.977

组别	例数	男/女（例）	年龄［岁，M（Q₁，Q₃)］	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）
早期LC组	44	34/10	82.0（80.0，85.0）	21.8±3.4
PTGD序贯LC组	25	17/8	82.0（80.0，83.5）	21.7±3.9
χ ²/Z/t值		0.711	0.369	0.111
P值		0.399	0.712	0.455
组别	例数	胆囊长径（cm， $\overset{ˉ}{x}$ ±s）	胆囊壁厚度（mm， $\overset{ˉ}{x}$ ±s）	ASA分级（例）
组别	例数	胆囊长径（cm， $\overset{ˉ}{x}$ ±s）	胆囊壁厚度（mm， $\overset{ˉ}{x}$ ±s）	Ⅰ级/Ⅱ级/Ⅲ级
早期LC组	44	9.3±3.9	5.3±1.9	5/31/8
PTGD序贯LC组	25	9.8±2.2	5.8±1.8	3/17/5
χ ²/Z/t值		-0.589	-1.070	0.047
P值		0.279	0.144	0.977

组别	例数	手术时间(min)	术中失血量(ml)	术后24h腹腔引流量(ml)
早期LC组	44	42.3±5.8	15.7±8.6	28.3±4.9
PTGD序贯LC组	25	40.6±5.5	9.1±4.7	21.5±4.4
t值		1.192	3.541	5.744
P值		0.119	0.000	0.000
组别	例数	引流管拔除时间(d)	肠功能恢复时间(h)	术后平均住院日(d)
早期LC组	44	2.4±1.1	24.2±5.5	5.5±2.2
PTGD序贯LC组	25	2.2±0.9	23.6±5.6	5.4±2.1
t值		0.773	0.433	0.184
P值		0.221	0.333	0.427

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