Value of Laparoscopic Appendectomy in the Elderly Patient
Value of Laparoscopic Appendectomy in the Elderly Patient
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DOI：
10.1007/s00268-008-9916-y
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发表时间：
2009-05-01
影响因子：
2.6
通讯作者：
Lantsberg, Leonid
中科院分区：
文献类型：
--
作者：
Kirshtein, Boris;Perry, Zvi Howard;Lantsberg, Leonid
老年患者(60岁及以上)的急性阑尾炎(AA)是一个具有挑战性的问题，当穿孔存在时，其发病率和死亡率很高。我们假设腹腔镜阑尾切除术(LA)可以使早期正确的诊断成为可能，并且在老年患者中具有优势。我们对因疑似AA而接受腹腔镜阑尾切除术的患者进行了回顾。老年患者的数据与年轻患者(18岁至60岁)的数据进行比较。54名老年患者和423名年轻患者接受了LA。60岁以上的患者有更多的合并症，需要更频繁地使用抗凝剂。老年患者的术前影像(超声或计算机断层扫描)明显更常见(36%比15%)，并且与急性阑尾炎的高确认率(78%比55%)有关，这使得老年患者的阴性手术探查率降至4.1%，而年轻患者的阴性手术探查率为10.2%。老年患者并发阑尾炎和中转的发生率较高。这导致了手术时间的延长和住院时间的延长。两组的总体并发症发生率相当，感染并发症或与手术部位相关的并发症的发生率无差异。在我们的系列中，没有阑尾切除术后的死亡。在老年人群中，腹腔镜阑尾切除术是安全的，并且与发病率的任何增加无关。老年患者并发阑尾炎的高发病率影响了手术时间和术后住院时间，也可能导致中转开腹手术的比率增加。老年患者术前使用腹部CT扫描是强制性的，以提供早期诊断，并在怀疑急性阑尾炎时减少不必要的手术探查。
Acute appendicitis (AA) in elderly patients (60 years of age and older) is a challenging problem associated with significant morbidity and mortality when perforation is present. We hypothesized that laparoscopic appendectomy (LA) would enable an earlier correct diagnosis and have advantages in elderly patients.We performed a retrospective review of patients who underwent laparoscopic appendectomy for suspected AA. Data of elderly patients were compared to data of younger patients (18 to < 60 years of age).Fifty-four LA were performed in elderly patients and 423 in younger patients. Patients over the age of 60 years had more co-morbidities and required more frequent use of anticoagulants. Preoperative imaging (ultrasound or computerized tomography) was significantly more frequent in elderly patients (36% versus 15%), and was associated with a higher rate of confirmation of acute appendicitis (78% versus 55%), which allowed a decrease in the rate of negative surgical explorations to 4.1% in elderly patients compared to 10.2% in younger patients. Complicated appendicitis and conversions were more frequent in the elderly patients. This resulted in prolonged operative time and longer hospital stay for this group. The overall complication rate was equivalent in the two groups, without differences in the occurrence either of infectious complications or of complications related to surgical site. There were no deaths following appendectomy in our series.Laparoscopic appendectomy is safe in the elderly population and is not associated with any increase in morbidity. The high incidence of complicated appendicitis in elderly patients affects operative time and length of hospital stay following laparoscopic appendectomy, and it can also lead to an increased rate of conversion to an open procedure. Use of preoperative abdominal computerized tomography scan is mandatory in elderly patients to provide an early diagnosis and to decrease unnecessary surgical exploration when acute appendicitis is suspected.