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1、华北国防医药2006年10月第18卷第5期MedJNatDefendingForcesinNorthChina,Oct.2006,Vol.18,No.5·320·老年腹腔镜胆囊切除术围手术期处理11211尚培中,周凤桐,李永庆,贾国洪,苗建军(11解放军251医院普通外科,河北张家口075000;21锡林郭勒军分区医院外科,内蒙古锡林浩特026000)摘要:目的:探讨老年胆囊结石患者腹腔镜胆囊切除术(laparoscopiccholecystectomy,LC)的临床特点及围手术期处理。方法:回顾性分析1999年4月～2
2、005年12月行LC的547例老年胆囊结石患者的临床资料。结果:547例中372例(6810%)合并有不同程度的糖尿病、心血管疾病或支气管疾病。537例成功完成手术,8例中转开腹,2例放弃。合并心肌缺血、心律失常的87例中,术后46例症状及心电图明显改善。将注射用内给氧随术后静脉给药替代过去的吸氧以保持正常血氧饱和度。术后胆漏2例,分别经保守治疗、内镜鼻胆管引流治愈。结论:对老年LC应加强围手术期处理,灵活采取不同的处理方法。应用超声刀、低压气腹及内给氧有利于降低手术风险。关键词:胆石症;胆囊炎;胆囊切除术,腹腔镜;手术
3、方法;老年病人中图分类号:R657.4文献标识码:A文章编号:100920878(2006)0520320203PerioperativeManagementofLaparoscopicCholecystectomyinElderlyPatients11211SHANGPei2zhong,ZHOUFeng2tong,LIYong2qing,JIAGuo2hong,MIAOJian2Jun(1.DepartmentofGeneralSurgery,The251stHospi2talofPLA,Zhangjiakou,Heb
4、ei075000,China;2.DepartmentofSurgery,HospitalofXilinguoleMilitarySubareaofInnerMongoliaMilitaryCommand,Xilinhaote,InnerMongolia026000,China)Abstract:Objective:Toevaluatetheclinicalcharacteristicsandfeaturesoflaparoscopiccholecystectomy(LC)inelderlypatientswithgal
5、l2stone.Methods:Wereviewedclinicaldataof547elderlypatientswithgallstonwhoreceivedLCatourhospitalduringApril1999andDecem2ber2005.Results:547elderlypatientswithgallstonewereaccompaniedbydiabetes,and/orcardiovasculardiseasesorbronchitis.Laparoscop2iccholecystectomyw
6、ascompletedsuccessfullyin537patientswith8transferredtoopencholecystectomyand2givenup.46caseswithcardi2ovasculardiseasesimprovedinsymptomsand/oronelectrocardiograms.Carbamideproxideforinjectiontooktheplaceofoxygen.Bileleakagehappenedin2casesafteroperationwhichreco
7、veredafterconservativemanagementinonepatientandendoscopicnasobiliarydrainageinan2other.Conclusion:Intensiveperioperativemanagementoflaparoscopiccholecystectomymayreducetheoperativerisk.HarmonicScalpel,low2erpneumaticabdomenandcarbamideproxideforinjectionmayincrea
8、sethesuccessrate.Keywords:Cholelithiasis;Cholecystits;Cholecystectomy,laparoscope;Operativemethod;Elderlypatients老年人多合并糖尿病、原发性高血压、心脑血管病器9例,术中安装临时心脏起搏器5例,陈旧性脑梗死
