摘要
目的探讨抗血栓治疗的老年患者急性胆囊炎腹腔镜手术的可行性和安全性。方法根据纳入和排除标准,回顾性分析2015年1月至2018年12月南京医科大学附属江宁医院胃肠胰外科及丹阳市人民医院普外科收治的老年急性胆囊炎伴或不伴胆囊结石患者60例,均采取腹腔镜手术。依据患者术前抗血栓药物使用情况,分为抗血栓组(24例)和非抗血栓组(36例)。比较2组患者临床基本资料及术中、术后指标。结果2组美国麻醉医师协会(ASA)分级、术前体力状态分级差异均有统计学意义(P均<0.05),抗血栓组分级高于非抗血栓组;抗血栓组经皮冠状动脉介入治疗和脑梗死患者比例均高于非抗血栓组(P均<0.05)。非抗血栓组中转开放率为8.3%,抗血栓组为12.5%,差异无统计学意义(P=0.329)。2组手术时间、术中出血量、出血量>500 ml患者占比、术中输血率差异均无统计学意义(P均>0.05)。与非抗血栓组相比,抗血栓组中位住院时间延长[19 d vs 9 d,P<0.001],术后入住重症监护室患者比例升高(37.5%vs 8.3%,P=0.012)。抗血栓组术后总并发症发生率高于非抗血栓组(50.0%vs 13.9%,P=0.002),但2组术后再出血和深静脉血栓发生率差异均无统计学意义(P均>0.05)。结论老年急性胆囊炎患者在抗血栓治疗期间采用积极的腹腔镜手术治疗,虽然术后存在并发症风险,但再出血率和深静脉血栓发生率与非抗血栓治疗患者相当。积极的腹腔镜手术能够使老年急性胆囊炎患者获益。
Objective To investigate the feasibility and safety of laparoscopic cholecystectomy in elderly patients on antithrombotic therapy.Methods According to the inclusion and exclusion criteria,60 elderly patients with acute cholecystitis with or without cholecystolithiasis admitted to Department of Gastrointestinal Pancreatic Surgery Department of Jiangning Hospital Affiliated to Nanjing Medical University and Department of General Surgery of the People's Hospital of Danyang from January 2015 to December 2018 were retrospectively analyzed.All patients underwent laparoscopic surgery.According to the preoperative use of antithrombotic drugs or not,the patients were divided into either an antithrombotic therapy group(n=24)or a non-antithrombotic therapy group(n=36).The basic clinical data and intraoperative and postoperative indicators were compared between the two groups.Results The ASA grade and preoperative physical status grade in the antithrombotic therapy group were significantly higher than those of the non-antithrombotic therapy group(P<0.05 each).The proportion of patients with percutaneous coronary intervention and cerebral infarction in the antithrombotic therapy group were significantly higher than those of the non-antithrombotic therapy group(P<0.05 each).The rate of conversion to open surgery was 8.3%in the non-antithrombotic therapy group and 12.5%in the antithrombotic therapy group,with no statistically significant difference between them(P=0.329).There was no significant differences in operative time,intraoperative blood loss,proportion of patients with 500 ml of blood loss,or intraoperative transfusion rate between the two groups(P>0.05 each).The median length of hospital stay was longer(19 d vs 9 d,P<0.001),and the proportion of patients admitted to the ICU after surgery was higher(37.5%vs 8.3%,P=0.012)in the antithrombotic therapy group than in the nonantithrombotic therapy group.The incidence of total postoperative complications in the antithrombotic therapy group was higher than that of the non-antithrombotic therapy group(50.0%vs 13.9%,P=0.002),but there was no significant difference in the incidence of postoperative rebleeding or deep vein thrombosis between the two groups(P>0.05 each).Conclusion Laparoscopic cholecystitis in elderly patients on antithrombotic therapy is associated with some postoperative complications,but there is no significant difference in the risk of rebleeding and deep vein thrombosis when compared with patients not receiving antithrombotic therapy.Aggressive laparoscopic surgery can benefit elderly patients with acute cholecystitis.
作者
周纲
顾兴伟
Zhou Gang;Gu Xingwei(Department of Gastrointestinal Pancreatic Surgery,the Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing 211100,China;Department of General Surgery,the People's Hospital of Danyang,Danyang 212300,China)
出处
《中华临床医师杂志（电子版）》
CAS
北大核心
2021年第9期660-665,共6页
Chinese Journal of Clinicians(Electronic Edition)
关键词
急性胆囊炎
腹腔镜
老年
抗血栓
安全性
Acute cholecystitis
Laparoscopy
Elderly
Anti-thrombotic
Safety
