摘要
目的:探讨高龄残余胆囊结石的预防与诊疗。方法:回顾分析2011年1月至2021年12月收治的25例高龄残余胆囊结石患者的临床资料,其中男11例,女14例,年龄≥60岁,平均(68.6±6.6)岁,患者既往均行腹腔镜胆囊切除术,与本次手术间隔时间为(47.5±17.2)个月。总结术前诊断、术中操作、术后管理及出院后随访的相关内容。结果:25例高龄患者均顺利完成腹腔镜残余胆囊切除术,无一例中转开腹。手术时间平均(79.2±21.6)min,术中出血量(50.0±14.4)mL。术后第1天均进食流质并下床活动,术后腹腔负压引流管引流液均为淡血性液体,引流量(70.8±18.8)mL,引流管拔除时间平均(4.4±1.3)d。术后均未发生胆漏、出血、腹腔感染等并发症,患者顺利出院。术后平均住院(6.7±2.2)d。术后病理均为残余胆囊伴慢性炎症,无恶性病变。随访12个月,均无异常。结论:高龄残余胆囊结石的预防是关键,术前诊断是基础,腹腔镜残余胆囊切除术需要特殊的技巧,手术安全、可靠,值得推广。
Objective:To investigate the prevention,diagnosis and treatment of elderly patients with residual gallbladder stones.Methods:A retrospective analysis was performed on clinical data of 25 elderly patients with residual gallstones from Jan.2011 to Dec.2021,including 11 males and 14 females.All patients were 60 years old or older with the average age of(68.6±6.6)years.The 25 patient had undergone previous laparoscopic cholecystectomy with a mean interval of(47.5±17.2)months.The preoperative diagnosis,intraoperative procedures,postoperative management and post-discharge follow-up were summarized.Results:All the 25 elderly patients were performed laparoscopic residual cholecystectomy successfully and none was transferred to laparotomy.The operation time was(79.2±21.6)min.The amount of intraoperative bleeding was(50.0±14.4)mL.All patients received liquid diet and ambulation on the first day after surgery.The drainage fluid of abdominal drainage tube with negative pressure after operation were pale bloody with drainage volume of(70.8±18.8)mL.The removal time of the drainage tube was(4.4±1.3)d after operation.None had complications such as bile leakage,hemorrhage and abdominal infection.All patients recovered and were discharged uneventfully.The postoperative hospital stay was(6.7±2.2)d.Postoperative pathology suggested residual gallbladder with chronic inflammation and no malignant l esions.There were no abnormalities during the 12-month follow-up.Conclusions:For elderly patients with residual gallbladder stones,prevention is critical,preoperative diagnosis is the basis,and laparoscopic residual cholecystectomy is safe and reliable with technical specificity and worthy to be popularized.
作者
王荇
张云
张淼
沈正海
WANG Xing;ZHANG Yun;ZHANG Miao(Department of General Surgery,the Affiliated Yixing Hospital of Jiangsu University,Yixing 214200,China)
出处
《腹腔镜外科杂志》
2023年第8期609-613,共5页
Journal of Laparoscopic Surgery
基金
2022无锡市卫健委科研青年项目(Q202239)。
