胆总管结石合并胆囊结石老年患者腹腔镜与传统手术治疗比较

Comparative Study between Laparoscopic Cholecystectomy and Traditional Open Surgery in Elderly Patients with Choledocholithiasis Complicated with Cholecystolithiasis

中文关键词: 腹腔镜胆总管探查术, 胆总管结石, 胆囊结石, 老年人

英文关键词: laparoscopic common bile duct exploration (LCBDE)choledocholithiasischolecystolithiasisthe elderly

中文摘要:

      目的 探讨胆总管结石合并胆囊结石老年患者经腹腔镜胆囊切除、胆总管切开探查取石术与传统开腹手术的临床疗效.方法 总结分析2012年12月-2015年12月复旦大学附属华东医院普外科97例胆总管结石合并胆囊结石老年患者的临床资料,分为2组:腹腔镜手术组55例,传统开腹手术组42例,比较2组患者手术时间、术中出血量、术后肛门排气时间、术后住院时间、住院费用及术后并发症发生情况.结果 2组患者手术均成功,治愈后出院,无死亡病例.腹腔镜手术组术后出现2例胆总管残余结石,传统开腹手术组术后出现5例胆总管残余结石及3例伤口感染,2组均无胆总管狭窄、胆管炎及腹腔感染者,2组术后并发症发生情况差异无统计学意义(P＞0.05).腹腔镜手术组手术时间(105.6±41.6) min vs(154.9±51.3) min、术中出血量中位数(5vs 40) mL、术后首次排气时间(2.1±0.9)dvs (4.2±1.6)d、术后住院时间中位数(5 vs 9)d、住院费用(25 660.7±7 699.4)元vs (32 257.3±13 996.1)元,少于传统开腹手术组,差异有统计学意义(P＜0.05);结论 经腹腔镜胆囊切除、胆总管切开探查取石术治疗老年胆总管结石合并胆囊结石安全、有效,良好的围手术期处理是老年患者手术成功的重要保障.

英文摘要:

      Objective Todiscuss the clinical curativeeffectsoflaparoscopiccholecystectomy,laparoscopiccommon bile duct exploration (LCBDE) and traditional open surgery on elderly patients with choledocholithiasis complicated with cholecystolithiasis.Methods A retrospective analysis was made to the clinical data of 97 elderly patients with choledocholithiasis complicated with cholecystolithiasis hospitalized in Department of Surgery,Huadong Hospital affiliated to Fudan University during the period from December 2012 to December 2015;the 97 patients were divided into 2 groups:laparoscopy group (n =55) and traditional open surgery group (n =42);a comparative study was made between the 2 groups in operation lasting time,bleeding volume in operation,the first time of fart after operation,hospitalization duration,hospitalization cost and the occurrence of complications after operation.Results All the operations in both groups were successful and the patients were discharged with good recovery,no death occurred;residual stones in common bile duct were found in 2 cases in laparoscopy group and 5 cases in traditional open surgery group,incision infection occurred in 3 cases in traditional open surgery group,no cases occurred common bile duct stenosis,cholangitis and abdominal infection in both groups.Between the 2 groups,the operation lasting time was (105.6±41.6) minutes vs (154.9±51.3) minutes,the bleeding volume in operation was 5 mL vs 40 mL,first time of fart after operation was (2.1±0.9) days vs (4.2± 1.6) days;the median hospitalization duration was 5 days vs 9 days,hospitalization cost was RMB (25 660.7±7 699.4) yuan vs RMB (32 257.3±13 996.1) yuan,the differences between the 2 groups were of statistical significance (P＜0.05).there existed no statistical difference in the occurrence of complications after operation between the 2 groups (P＞0.05).Conclusions Laparoscopic cholecystectomy and laparoscopic common bile duct exploration (LCBDE) are safe and effective for elderly patients with choledocholithiasis complicated with cholecystolithiasis,good perioperative management is important for successful operation in elderly patients.