CAJ | 학술논문

目的：探讨腹腔镜技术在65岁以上老年急腹症患者中的应用价值。方法回顾性分析2006年1月至2014年6月在解放军总医院因急腹症接受腹腔镜手术138例65岁以上患者的临床资料（腹腔镜组），并与同期接受开腹探查手术的170例65岁以上急腹症患者临床资料（开腹组）进行比较分析。结果腹腔镜组与开腹组相比，术中出血量减少[（107．1±47．7） ml比（163．6±106．5） ml， P＝0．000]，术后并发症发生率降低[2．9％（4／138）比12．9％（22／170）， P＝0．022]，住院时间缩短[（10．5±7．5） d 比（16．5±9．9） d， P＝0．044]，术后下地活动时间和术后胃肠功能恢复时间提前[（25．6±7．7） h比（33．2±5．6） h， P＝0．020；（36．9±9．1） h比（49．3±10．6） h， P＝0．031]。急性阑尾炎、上消化道穿孔和肠梗阻患者腹腔镜组在住院时间、术后下地活动时间、术后胃肠功能恢复时间和术中出血量等方面明显优于开腹组（P＜0．01）；而对于结肠穿孔和肠系膜血管病变患者，两组在住院时间、术中出血量和术后胃肠功能恢复时间等方面差异无统计学意义（P＞0．05）。结论腹腔镜手术对于65岁以上急腹症尤其急性阑尾炎、上消化道穿孔和肠梗阻患者安全有效。
목적：탐토복강경기술재65세이상노년급복증환자중적응용개치。방법회고성분석2006년1월지2014년6월재해방군총의원인급복증접수복강경수술138례65세이상환자적림상자료（복강경조），병여동기접수개복탐사수술적170례65세이상급복증환자림상자료（개복조）진행비교분석。결과복강경조여개복조상비，술중출혈량감소[（107．1±47．7） ml비（163．6±106．5） ml， P＝0．000]，술후병발증발생솔강저[2．9％（4／138）비12．9％（22／170）， P＝0．022]，주원시간축단[（10．5±7．5） d 비（16．5±9．9） d， P＝0．044]，술후하지활동시간화술후위장공능회복시간제전[（25．6±7．7） h비（33．2±5．6） h， P＝0．020；（36．9±9．1） h비（49．3±10．6） h， P＝0．031]。급성란미염、상소화도천공화장경조환자복강경조재주원시간、술후하지활동시간、술후위장공능회복시간화술중출혈량등방면명현우우개복조（P＜0．01）；이대우결장천공화장계막혈관병변환자，량조재주원시간、술중출혈량화술후위장공능회복시간등방면차이무통계학의의（P＞0．05）。결론복강경수술대우65세이상급복증우기급성란미염、상소화도천공화장경조환자안전유효。
Objective To explore the clinical application of laparoscopy in gastrointestinal abdominal emergency operation for patients over 65 years old. Methods Clinical data of 138 cases (age > 65 years) with acute abdomen undergoing laparoscopic surgery from January 2006 to June 2014 were analyzed retrospectively. Data of 170 cases treated by laparotomy during the same period were enrolled as controls. Results The laparoscopy group and the laparotomy group showed statistically significant differences in blood loss [(107.1±47.7) ml vs. (163.6±106.5) ml, P=0.000], postoperative complications rate [2.9%(4/138) vs. 12.9%(22/170), P=0.022], hospital stay [(10.5 ±7.5) d vs. (16.5±9.9) d, P=0.044], postoperative ambulation time[(25.6±7.7) h vs. (33.2±5.6) h, P=0.020], and recovery time of postoperative gastrointestinal function [(36.9±9.1) h vs. (49.3±10.6) h, P=0.031]. Patients with acute appendicitis, upper digestive tract perforation and bowel obstruction in the laparoscopy group were superior to those in the laparotomy group in hospital stay, postoperative ambulation time, recovery time of postoperative gastrointestinal function and intraoperative blood loss (all P<0.01), while no significant differences in colon perforation and mesentery diseases were found in hospital stay, intraoperative blood loss and recovery time of postoperative gastrointestinal function between the two groups (all P>0.05). Conclusions Compared with laparotomy, the laparoscopy offers the advantages of less trauma, faster recovery, shorter hospital stay, and lower postoperative complications rate for patients over 65 years with acute abdomen.