| [Objectives]To learn the clinical characteristics of cholecystectomy in elderly patients (≥60 years old) and provide references for improving the safety of surgical treatment of gallbladder disease in this group.[Methods]The clinical date of 1583 patients who underwent only cholecystectomy from June 2012 to December 2015 in Ganmei Hospital Affiliated to Kunming Medical University was retrospectively analyzed. All the patients were divided into two groups in age, elderly group(≥60 years old) and non-elderly group(<60 years old). The former was defined as Group A, including open cholecystectomy(Group A OC) and laparoscopic cholecystectomy(Group A LC). The latter was defined as Group B, including open cholecystectomy(group B OC) and laparoscopic cholecystectomy (group B LC). The relationship between age, gender and the choice of surgical procedure was analyzed respectively. Preoperative comorbidities and postoperative pathological diagnosis, mortality, incidence and characteristics of complications in each group were studied. Operative time, bleeding volume, recovery time of gastrointestinal function, drainage indwelling rate and duration, conversion rate and reasons, length of hospital stay, preoperative preparation time, postoperative hospital stay, hospitalization costs in different surgery procedures were also compared between Group A and Group B.[Results]1.1583 patients underwent cholecystectomy from June 2012 to December 2015. 402 cases were in group A(≥60 years old), accounted for 25.39%, age from 60to 96 years old,147 cases were male and 255 were female, the ratio was 1:1.7, Group A OC amounted 114 cases, Group ALC were 288 cases, OC/LC=1/2.5.1181 cases were in group B(11 to 59 years old), accounted for 74.61%,414 cases male,767 cases female, the ratio was 1:1.8, Group B OC were 185 cases and 996 cases in Group B LC. OC/LC=1/5.4.2. Age and procedure. The implementation rate of LC in Group A was lower than that of in Group B,288/71.64% vs 996/84.34%(P<0.01), OC was more common in Group A than Group B,114/28.36% vs 185/15.66%(P<0.01). The mean age in Group A who underwent OC was older than that in the patients with LC(P<0.01).3.Group A had a higher comorbidity rate,305/75.87%vs 253/21.42%(P<0.01), they were hypertension, diabetes, coronary disease, chronic lung disease and cerebral infarction in turn. Every comorbidity rate was higher than Group B, the difference was significant(P<0.01).The incidence rate of comorbidity in Group A with LC was higher than that in Group B, the difference was significant (P<0.01). Group A OC had more cases with hypertension, chronic lung disease than Group B OC (P<0.05) Group A with OC had higher proportion of chronic lung disease than LC. The proportion of LC was much higher than OC in Group A with diabetes (P<0.01).4. Gallbladder stone was the main indication of cholecystectomy, gallbladder stones in Group A were significantly higher than that in Group B,353/84.04% vs 903/76.46%(P<0.01). There was no significant difference between Group A and Group B in acute cholecystitis, chronic cholecystitis and adenomyomatosis of the gallbladder(P>0.05).Gallbladder polyps in Group B were more than Group A(P<0.05). Gallbladder carcinoma was more common in Group A (P<0.01). Patients in Group A OC with acute cholecystitis, gallbladder polyps were less than Group B OC (P<0.05). Patients with acute cholecystitis, gallbladder cancer in Group A were more likely to undergo OC(P<0.01),but for chronic cholecystitis,undergo LC (P<0.01).Group A had higher gangrene and perforation rate in acute cholecystitis,23/23.95% vs 40/13.98% (P< 0.05). For incidence in acute acalculous cholecystitis, there was no significant difference between Group A and Group B,9/9.28% vs22/7.69%(P> 0.05).5. The mortality of this study was 0%. The total incidence of postoperative complications in Group A was significantly higher than that in group B,15.92% vs 6.27%(P<0.01). The incidence of postoperative complications (direct and indirect complication) in Group A LC was 5.56%,3.31% in Group B LC, no significant difference (P>0.05). Postoperative complication rate(direct and indirect complication) in Group A OC was 42.41%,22.16% in Group B OC, the difference was significant (P<0.01). Direct complication incidence was higher in Group A than that in Group B,5.97% vs 1.69%(P<0.01).There was no difference between Group A LC and Group B LC in direct complication incidence (P>0.05). The incidence of direct complication in Group A OC was significantly higher than the Group B OC(P<0.01), the rate of incision infection was 14.91% in Group A OC, but Group B OC was 7.03% (P<0.01).Patients with OC have higher incision infection rate (P<0.01) and abdominal infection rate (P<0.05) than patients with LC in Group A. Indirect complication incidence was higher in Group A than that in Group B,9.95% vs 4.57%(P<0.01). The most common indirect complication in Group A was cardiovascular disorder, followed by respiratory dysfunction, urinary tract infection, deep venous thrombosis. The incidence rates of indirect complication between Group A LC, Group A OC and Group B LC, Group B OC were not statistically significant(respectively P>0.05, P=0.05).Incidence of cardiovascular complications in Group A LC and Group A OC were respectively higher than that in Group B LC and Group B OC(P<0.05). Indirect complications were more common in Group A OC when compared with Group A LC(P<0.01) cardiovascular complications stand out(P<0.01).6. There was no significant difference in the operative time, bleeding, gastrointestinal function recovery time between Group A LC, Group A OC and Group B LC, Group B OC(p>0.05). The indwelling rate of drainage tube in Group A LC was 33.33%, higher than that in group B 26.01%(P<0.05), and the retention time in Group A was significantly longer than that in Group B (P<0.01). No difference in the rate of drainage tube between the Group A OC and the Group B OC (P>0.05), but the indwelling time in Group A was longer (P<0.05). The volume of bleeding in Group A OC was greater than LC, operative time, gastrointestinal function recovery time and drainage tube indwelling time were apparently longer than LC, rate of drainage tube indwelling in OC was the highest, both of above had statistically significant difference (P<0.01).7. Conversion rate in Group A was 9.43%, and 5.95% in Group B, the difference was statistically significant (P<0.05).The main reason for conversion was difficult local dissection (such as severe gallbladder triangle adhesion, adhesion of the gallbladder wall to the surrounding organs, and "frozen samples" of the gallbladder wall).8. The length of hospital stay, preoperative preparation time and postoperative hospital stay were longer and hospitalization cost was higher in Group A than that in Group B, and the differences were statistically significant (P<0.01),instead of different surgery procedures. It was longer in length of stay, preoperative preparation time and postoperative hospital stay and higher in costs in OC group than that in LC group for elderly patients. [Conclusions]1. Patients with gallbladder disease in elderly population should be early treated with cholecystectomy. Older patients with more medical comorbidities, operation risk, conversion rate and costs, preoperative preparation time and length of hospital stay will be longer simultaneously. Female was the main population undergoing cholecystectomy. The OC rate in elderly patients (≥60 years old) was higher than non-elderly patients.2. LC can shorten the length of stay, preoperative preparation time and postoperative hospital stay, and also can low the costs of hospitalization. Operative time, gastrointestinal function recovery time and drainage tube indwelling time were significantly shorter than that in OC group. Therefore, LC should be the first choice for elderly patients with gallbladder disease.3. The incidence of postoperative complications in elderly patients was significantly higher than that in the non-elderly group, but there was no significant difference between the two groups. Conversion rate in elderly patients is significantly higher than that in non-elderly group, and the elderly patients with OC have higher postoperative complication rate than in non-elderly group. Hence, it is recommended that gallbladder disease should be treated as early as possible, so as to reduce the incidence of postoperative complications. |
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