hepatoАнналы хирургической гепатологииAnnaly khirurgicheskoy gepatologii = Annals of HPB Surgery1995-54642408-9524НЭИКОН ИСП10.16931/1/1995-5464.2024-3-13-21hepato-1142Research ArticleОСОБЕННОСТИ ГЕПАТОПАНКРЕАТОБИЛИАРНОЙ ХИРУРГИИ У БОЛЬНЫХ ПОЖИЛОГО И СТАРЧЕСКОГО ВОЗРАСТАSPECIFICS OF HEPATO-PANCREATO-BILIARY SURGERY IN ELDERLY AND SENILE PATIENTSОптимизация сроков выполнения холецистэктомии при этапном лечении острого холецистита у пациентов с холецистостомой в пожилом и старческом возрастеOptimization of cholecystectomy timing during staged treatment of acute cholecystitis in elderly and senile patients with cholecystostomyhttps://orcid.org/0000-0002-5166-9957ВагановаП. С.VaganovaP. S.

Ваганова Полина Сергеевна – заместитель главного врача по амбулаторно-поликлинической работе, врач-хирург

129336, Москва, ул. Стартовая, д. 4

Polina S. Vaganova – Deputy Chief Physician for Outpatient and Polyclinic Work, Surgeon

4, Startovaya str., Moscow, 129336

VaganovaPS@zdrav.mos.ruhttps://orcid.org/0000-0001-7234-4185МелконянГ. Г.MelkonyanG. G.

Мелконян Георгий Геннадьевич – доктор мед. наук, профессор, главный врач, врач-хирург

129336, Москва, ул. Стартовая, д. 4

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Georgy G. Melkonyan – Doct. of Sci. (Med.), Professor, Chief Physician, Surgeon

4, Startovaya str., Moscow, 129336

 2/1 bld. 1, Barrikadnaya str., Moscow, 125993

MelkonyanGG@zdrav.mos.ruhttps://orcid.org/0000-0002-1205-9152БуриевИ. М.BurievI. M.

Буриев Илья Михайлович – доктор мед. наук, профессор, врач-хирург

129336, Москва, ул. Стартовая, д. 4

Ilya M. Buriev – Doct. of Sci. (Med.), Professor, Surgeon

4, Startovaya str., Moscow, 129336

Imburiev@gmail.comКачуринС. А.KachurinS. A.

Качурин Сергей Александрович – заведующий хирургическим отделением

129336, Москва, ул. Стартовая, д. 4

Sergey A. Kachurin – Head of Surgery Department

4, Startovaya str., Moscow, 129336

KachurinSA@zdrav.mos.ruhttps://orcid.org/0000-0002-7966-2634ПчелинВ. В.PchelinV. V.

Пчелин Владимир Владимирович – врач-патологоанатом

129336, Москва, ул. Стартовая, д. 4

Vladimir V. Pchelin – Pathoanatomist

4, Startovaya str., Moscow, 129336

ГБУЗ “Госпиталь для ветеранов войн № 3 ДЗ города Москвы”РоссияHospital for War Veterans No. 3, Moscow Healthcare DepartmentRussian FederationГБУЗ “Госпиталь для ветеранов войн № 3 ДЗ города Москвы”; ФГБОУ ДПО “Российская медицинская академия непрерывного профессионального образования” Минздрава РоссииРоссияHospital for War Veterans No. 3, Moscow Healthcare Department; Department of Surgery, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian FederationRussian Federation2024300920242931321Copyright © Ваганова П.С., Мелконян Г.Г., Буриев И.М., Качурин С.А., Пчелин В.В., 20242024Ваганова П.С., Мелконян Г.Г., Буриев И.М., Качурин С.А., Пчелин В.В.Vaganova P.S., Melkonyan G.G., Buriev I.M., Kachurin S.A., Pchelin V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://hepato.elpub.ru/jour/article/view/1142Цель

Цель. Определить оптимальные сроки для выполнения лапароскопической холецистэктомии у больных пожилого и старческого возраста с холецистостомой.

Материал и методы

Материал и методы. Анализировали результаты лечения 37 пациентов старше 60 лет на различных сроках после формирования холецистостомы. Оценивали степень старческой астении, сопутствующие заболевания, технические особенности оперативного пособия, динамику послеоперационного периода, а также морфологические особенности воспалительных изменений в стенке желчного пузыря.

Результаты

Результаты. Преастения выявлена у 12 (32%) пациентов, легкая старческая астения – у 14 (38%), умеренная старческая астения – у 11 (30%). Полиморбидность определена у всех больных, у 23 выявлено ≥4 заболевания. В 3 (8%) наблюдениях лапароскопическую холецистэктомию выполнили через 3–9 сут после холецистостомии, в 15 (40,5%) – через 10–30 сут, в 15 (40,5%) – через 2–6 мес, в 4 (11%) – через 6 мес и более (1 конверсия).

Заключение

Заключение. Лапароскопическая холецистэктомия через 10–30 сут после холецистостомии у больных пожилого и старческого возраста является оптимальной, безопасной и доступной. Радикальное вмешательство в этот период не сопряжено с техническими сложностями. Сокращение сроков наружного дренирования желчного пузыря позволяет улучшить качество жизни пожилого пациента и его социальную адаптацию, а также сократить сроки послеоперационного восстановления. При обсуждении пациента старше 60 лет со специалистами по гериатрии необходимо учитывать коморбидный фон, полипрагмазию и старческую астению.

Aim

Aim. To determine optimal timing for laparoscopic cholecystectomy in elderly and senile patients with cholecystostomy.

Materials and methods

Materials and methods. Treatment results of 37 patients aged 60 years and over at different terms after cholecystostomy formation were analyzed. The degree of senile asthenia, concomitant diseases, technical features of surgical aid, dynamics of the postoperative period, as well as morphological features of inflammatory changes in the gallbladder wall were assessed.

Results

Results. Pre-asthenia was detected in 12 (32%) patients, mild senile asthenia – in 14 (38%) patients, and moderate senile asthenia – in 11 (30%) patients. Polymorbidity was determined in all patients, with 23 patients having four or more diseases. In 3 (8%), 15 (40.5%), 15 (40.5%), and 4 (11%) cases, laparoscopic cholecystectomy was performed 3–9 days, 10–30 days, 2–6 months, and 6 months or more (1 conversion) after cholecystostomy.

Conclusion

Conclusion. In elderly and senile patients, laparoscopic cholecystectomy performed 10–30 days after cholecystostomy is optimal, safe, and affordable. Radical intervention in this period is not associated with technical difficulties. Reduced terms of external drainage of the gallbladder contribute to improving the elderly patient’s quality of life and their social adaptation, while shortening the period of postoperative recovery. When planning surgical interventions in a patient over 60 years old, account should be taken of comorbidities, polypragmasy, and senile asthenia.

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The authors declare that there are no conflicts of interest present.