目的

探讨腹腔镜手术治疗高龄急性梗阻性化脓性胆管炎（AOSC）患者安全性和疗效。

方法

回顾性分析2019年7月至2023年9月在国家电网公司北京电力医院行腹腔镜手术治疗的67例AOSC患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男34例，女33例；年龄39～93岁，中位年龄72岁。根据年龄将患者分为高龄组（≥80岁，19例）和非高龄组（＜80岁，48例）。观察两组围手术期指标。两组手术时间、术后住院时间等比较采用t检验；术后并发症等比较采用χ²检验。

结果

高龄组术前冠状动脉粥样硬化性心脏病、高血压病、肝功能不全、低蛋白血症分别为6、12、15、8例，非高龄组相应为4、15、22、9例，高龄组术前合并症发生率明显高于非高龄组（χ²=5.793，5.760，6.036，3.921；P＜0.05）。两组患者手术顺利，无中转开腹，其中腹腔镜胆总管探查术（LCBDE）37例，腹腔镜经胆囊管胆总管探查术（LTCBDE）28例，腹腔镜经胆囊管汇入部微切开胆总管探查术（LTM-CBDE）2例。两组手术时间、术中出血量、术后住院时间差异均无统计学意义（P＞0.05）。LTCBDE患者术后平均住院时间为（9.3±1.9）d，明显短于LCBDE患者的（17.1±5.4）d（t=-7.286，P＜0.05）。患者治愈率均为100%。术后随访1～48个月，患者均健康生存，均无胆管损伤和胆总管结石复发。

结论

高龄AOSC患者术前合并症发生率高，在严格术前准备、精准把握手术时机及手术方式、围手术期严密监测的条件下，行腹腔镜手术是安全可行的，LTCBDE术式具有明显优势。

Objective

To evaluate the safety and efficacy of laparoscopic surgery for elderly patients with acute obstructive suppurative cholangitis （AOSC）.

Methods

Clinical data of 67 patients with AOSC who underwent laparoscopic surgery in Beijing Electric Power Hospital of State Grid Corporation of China from July 2019 to September 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them，34 patients were male and 33 female，aged 39-93 years，with a median age of 72 years. According to the age，all patients were divided into the elderly （≥80 years，n=19） and non-elderly groups （＜ 80 years，n=48）. Perioperative parameters were observed in two groups. Operation time and the length of postoperative hospital stay between two groups were compared by t test. The incidence of postoperative complications was compared by Chi-square test.

Results

There were 6，12，15 and 8 cases of atherosclerotic coronary heart disease，hypertension，hepatic insufficiency and hypoproteinemia before surgery in the elderly group，and 4，15，22 and 9 cases in the non-elderly group，respectively. The incidence of preoperative complications in the elderly group was significantly higher than that in the non-elderly group （χ²=5.793，5.760，6.036，3.921； P＜0.05）.All patients successfully completed laparoscopic surgery，and no case was converted to open surgery.37 cases underwent laparoscopic common bile duct exploration （LCBDE），28 cases received laparoscopic transcystic common bile duct exploration （LTCBDE） and 2 cases underwent micro-incision of the cystic duct confluence in common bile duct exploration （LTM-CBDE）. No significant differences were found in the operation time，intraoperative blood loss and length of postoperative hospital stay between two groups（P＞0.05）. The average length of postoperative hospital stay of patients treated with LTCBDE was （9.3±1.9） d，significantly shorter than （17.1±5.4） d of those undergoing LCBDE （t=-7.286， P＜0.05）. The cure rate of all patients was 100%. During postoperative 1-48 month follow-up，all patients normally survived without bile duct injury or recurrence of common bile duct stones.

Conclusions

The incidence of preoperative complications in elderly patients with AOSC is high. Laparoscopic surgery is safe and feasible under strict preoperative preparations，accurate surgical timing and technique and intimate perioperative monitoring.LTCBDE has evident advantages over alternative procedures.