Objective To explore the clinical effect of laparoscopic treatment of acute cholecystitis in the elderly. Methods Laparoscopic cholecystectomy was performed in 77 elderly patients with acute cholecystitis, and the curative effect was observed. Results Among 77 cases of LC, 74 cases were successful, 3 cases were converted to laparotomy due to severe inflammatory adhesion, and 4 cases showed choledocholithiasis during operation. All cases were successfully removed by LC combined with intraoperative choledochoscope, and no serious complications occurred in the whole group. Conclusion LC is safe and reliable for elderly patients with acute cholecystitis. Keywords the elderly; Cholecystectomy; Laparoscopic laparoscopic surgery has obvious advantages of less trauma and quick recovery. With the improvement of the operator's operation level and the accumulation of experience, as well as the emergence of new medical instruments, the scope of laparoscopic surgery is expanding. At present, it is widely used in gallbladder, gastrointestinal tract [1-2], liver [3], pancreas [4], hernia [5], urology [6] and obstetrics [7]. Acute cholecystitis is a common disease in surgery. With the maturity of laparoscopic cholecystectomy, all kinds of acute cholecystitis are no longer contraindications for laparoscopic cholecystectomy. However, elderly patients have many complications, rapid progress and poor surgical tolerance, so it is difficult for elderly patients with acute cholecystitis to undergo LC. The First Affiliated Hospital of Xinxiang Medical College performed laparoscopic cholecystectomy on 77 patients over 60 years old with acute cholecystitis from June 5, 2002 to February 5, 2007. As described below, the results are satisfactory. 1 Materials and Methods 1. 1 General information Among 77 cases, there were 2 males1case, and 56 females, aged 60-81year, with an average of (69 2) years. All of them showed pain or tenderness in the right upper abdomen. B-ultrasound showed that 54 cases of gallbladder were obviously enlarged, all of which showed that the gallbladder wall was thickened and rough, and there were floating flocs in the gallbladder. It is suggested that there are 69 cases of acute calculous cholecystitis and 8 cases of acute acalculous cholecystitis. 1 1 case B ultrasound showed that the common bile duct was slightly dilated by 0.8 ~ 1. 1 cm, and no intrahepatic or extrahepatic bile duct stones were found. The onset time: 72 cases (72 hours). There were 59 cases (76.62%) of other medical diseases before operation, including two or more diseases * * 4 1 case (53.25%), hypertension in 39 cases (50.65%), diabetes 16 cases (20.78%). According to the findings of laparoscopic surgery and pathological classification, there were 67 cases of acute simple cholecystitis, 9 cases of suppurative cholecystitis and gangrenous cholecystitis 1 case. Operation method 1.2 after general anesthesia with tracheal intubation, pneumoperitoneum was established routinely, and the pressure of CO2 pneumoperitoneum was controlled at 1.33 ~ 1.60 kPa. Using four-hole technique, the adhesion around gallbladder and Calot triangle was observed by inserting laparoscopy, and the omentum and adhesion tissue were separated, and the gallbladder was exposed first. If the gallbladder tension is high, decompression is performed at about 2 cm below the gallbladder. If there was a history of biliary pancreatitis and jaundice, bilirubin increased directly before operation, and B-ultrasound showed bile duct dilatation. All patients underwent cholangiography through cystic duct during operation. Drainage tube was placed under the liver after LC with infection and unclear intraoperative display, and it was converted to laparotomy in severe cases. Results Among 77 cases of acute cholecystitis, LC was successful in 74 cases, among which 1 1 cases had common bile duct stones in 4 cases, all of which were successfully removed by choledochoscope during operation. Three cases were converted to open cholecystectomy due to severe inflammatory adhesion in Calot triangle, and the conversion rate was 3.90%. The operation time was (65 25) min. Postoperative abdominal drainage was (60 25) ml. Generally, the drainage tube was removed 1 ~ 3 days after operation, and the patient was hospitalized (5 2) days after operation. No serious complications such as extrahepatic bile duct injury, gallbladder artery bleeding after reoperation, intestinal injury, biliary peritonitis and abdominal abscess occurred. 3. Discuss 3. 1 Clinical characteristics of acute cholecystitis in the elderly.

(1) The onset is hidden and the clinical signs are atypical; (2) the condition is serious and the condition is progressing rapidly; (3) Many diseases are related to other organs. Before the onset, 65% of the elderly had serious accompanying diseases, respiratory diseases ranked first, followed by cardiovascular diseases. These accompanying diseases have a great influence on the prognosis, and the mortality rate with or without accompanying diseases is 65438 06% and 7% respectively. 3.2 Timing of operation The mortality rate of conservative treatment of acute cholecystitis in the elderly is high. Once diagnosed, we must strive for early surgery. Mao Jingxi and others [8] think that the only factor affecting the operation of acute cholecystitis is the onset time, and Cheng and others [9] think that the best time for laparoscopic cholecystectomy is 72 h after the onset. Koo et al. [10] also believe that the course of disease is the main factor that determines the success of LC. The author believes that once acute cholecystitis occurs due to factors such as vascular sclerosis in the elderly, the course of the disease progresses rapidly, and the conservative treatment effect is poor, which is easy to cause gallbladder suppuration, pus accumulation, gangrene and perforation, with serious consequences. LC should be performed within 48 ~ 72 h of onset, except for patients whose general condition is too poor to tolerate surgery. At this time, the adhesion between gallbladder and hilum is mostly simple fiber, local edema is not serious, and it is easy to separate from the surrounding adhesion, which can improve the surgical effect, reduce the rate of conversion to laparotomy and the incidence of serious complications, and shorten the postoperative hospitalization time. 3.3 Problems that should be paid attention to during the operation should be shortened as much as possible, the operation should be gentle, ECG monitoring should be strengthened, pneumoperitoneum should be established at low flow rate, and the continuous pneumoperitoneum pressure should not be too high, and it should be controlled at 1.33 ~ 1.60 kPa. Pay attention to prevent subcutaneous emphysema during puncture, and discharge CO2 gas from abdominal cavity after operation. The anesthesia should not be too deep, so as to ensure that the patient can wake up quickly when the operation is completed. [During acute inflammation, the gallbladder is often swollen, congested and edematous, and it adheres to the surrounding area, and the anatomy is unclear. When separating adhesions, first separate the adhesions around the gallbladder, and then separate the adhesions gradually to the junction of the ampulla of the gallbladder and the cystic duct, confirm the ampulla of the gallbladder, dissect the cystic duct, and then track the distal end of the cystic duct, but don't deviate too much to the common bile duct, so as not to damage the common bile duct (liver), which is especially important when the cystic duct is short and thick. When the tension is too high, it is difficult to clamp, which prevents Calot triangle and gallbladder neck tube from being exposed. At this time, decompression can be performed at the bottom of gallbladder, but the decompression amplitude should not be too large, and a certain tension should be maintained, which is beneficial to Calot triangle dissection and gallbladder dissection. If the gallbladder wall thickness and edema are still difficult to grasp, cut at the ampulla of the gallbladder and grasp it in a single layer. In principle, it is better to injure gallbladder than bile duct. In acute inflammation, gallbladder tissue is edematous and fragile, and ossification of cystic duct should be avoided when separating. When clamping the cystic duct with titanium clip, don't use too much force, so as not to clamp part of the cystic duct, which will cause postoperative stump necrosis, shedding and bile leakage. In case of stone impaction in the neck of gallbladder or cystic duct, it is necessary to separate the cystic wall next to the stone impaction in the neck of gallbladder or cystic duct, and then separate the Calot triangle, so as to understand the relationship between cystic duct and common bile duct (liver) or right hepatic duct, and then treat the cystic duct. It's really difficult to dissect Calot triangle. Retrograde, retrograde and antegrade cholecystectomy should be considered. For triangular hemorrhage of gallbladder, don't panic, don't pinch or coagulate at will, so as not to cause damage to the side wall of bile duct or incomplete or complete bile duct atresia and electric burn. The correct treatment is to quickly clamp the bleeding point, clean up the operating field, and ligate after dissection.