Use of the Tokyo Guidelines to evaluate acute cholecystitis in elderly adults

DOI 機関リポジトリ Web Site

書誌事項

タイトル別名
  • Tokyo Guidelines に準じた高齢者急性胆嚢炎の解析

この論文をさがす

抄録

type:TOHO University Scholarly Publication

原著

Background: We used the Tokyo Guidelines to evaluate outcomes of early laparoscopic cholecystectomy(ELC)among elderly patients with acute cholecystitis(AC). Methods: We retrospectively reviewed the records of 225 patients, who were classified into 2 age groups: 172 patients were younger than 75 years, and 53 patients were 75 years or older. Results: Presence of comorbidities, use of anticoagulant therapy, and high American Society of Anesthesiologists(ASA)class were significantly more frequent among elderly patients as compared with younger patients. In addition, severity grade was significantly higher among elderly patients than among younger patients(p=0.0454). Among patients with Grade I disease, no significant differences were seen in the rates of conversion to open surgery or postoperative complications. Among patients with Grade II disease, postoperative complications were significantly more frequent among elderly patients(8.0%in younger patients vs 25%in elderly patients; p=0.0299). Among elderly patients, rates of conversion to open surgery and postoperative complications did not significantly differ between the ELC group and the delayed laparoscopic cholecystectomy(DLC)group. Preoperative and total hospital stays were significantly shorter for elderly patients undergoing ELC than for elderly patients undergoing DLC. Conclusions: ELC is a satisfactory treatment for elderly adults with the Tokyo Guidelines Grade I or II AC.背景: 急性胆嚢炎の国際版ガイドラインであるTokyo Guidelinesに準じて高齢者急性胆嚢炎症例に対する早期腹腔鏡下胆嚢摘出術(early laparoscopic cholecystectomy:ELC)の検討を行ったので報告する.対象ならびに方法: 当科で経験した急性胆嚢炎症例225例を対象とした.75歳未満の若年者群172例と75歳以上の高齢者群53例の2群に分けて比較検討を行った.結果: 高齢者群は若年者群と比較し併存疾患の有無,抗凝固剤内服,American Society of Anesthesiologists(ASA)分類高値例が有意に多い結果となった.さらに高齢者群ではTokyo Guidelinesの重症度分類において有意に重症度が高い結果となった(p=0.0454).重症度がGrade Iの症例は開腹移行率,術後合併症で高齢者群と若年者群との間に有意差は認めなかった.Grade IIの症例において高齢者は術後合併症が有意に多い結果となった(若年者群,8.0%;高齢者群,25%;p=0.0299).高齢者群内の比較ではELC施行例と待機的腹腔鏡下胆嚢摘出術施行症例の間において,開腹移行率,術後合併症で有意差は認めなかった.また,術前待機期間,総入院期間はELC施行症例で有意な短縮を認めた.結語: 高齢者に対するELCは有益な治療方針であると考えられた.また,急性胆嚢炎国際ガイドラインにおけるTokyo Guidelinesに準じた重症度Grade I,IIの双方においても施行可能と考えられた.

収録刊行物

キーワード

詳細情報 詳細情報について

問題の指摘

ページトップへ