三镜联合治疗老年人梗阻性胆管结石的临床观察  

Clinical observation on treatment of elderly patients with obstructive bile duct stone with combined three endoscopes

作　　者：卜双龙[1] 张树友[1] 周云生[1] 余子健[2] 梁庆模[1] 余枭[3] 

机构地区：[1]南华大学附属南华医院普外科,湖南省衡阳市421002 [2]南华大学附属第一人民医院普外科 [3]中南大学附属湘雅三院普外科

出　　处：《中华老年医学杂志》2007年第7期504-506,共3页Chinese Journal of Geriatrics

摘　　要：目的探讨十二指肠镜、腹腔镜及术中纤维胆道镜（简称三镜）联合治疗老年人梗阻性胆管结石的临床效果。方法收集老年梗阻性胆管结石患者65例。分为三镜组与开腹组，比较两组术前准备时间、术中出血量、术后住院日、腹腔引流时间、术后并发症、残余结石率、胃肠道恢复时间、病死率及随诊结果。结果腹腔引流时间及残石率在两组中差异无统计学意义（P〉0．05）。开腹组35例，多器官功能衰竭死亡3例，术前准备时间1～3d；三镜组30例，术前准备5～7d，无死亡病例。三镜组术中出血量、术后住院时间、术后并发症、胃肠道恢复时间均明显短于或少于开腹组[分别为（82．7±35．2）ml和（203．4±45．1）ml、（9．1±4．3）d和（16．7±2．2）d、（1．7±0．5）例和（4．0±1．4）例、（2．7±1．3）d和（3．5±0．7）d]（均为P〈0．05）。结论老年梗阻性胆管结石患者施行三镜联合治疗是安全可行的，疗效明显优于传统开腹手术。Objective To investigate the clinical effect of combined three endoseopes in treatment of elderly patients with obstructive bile duct stone. Methods A total of 65 elderly patients with obstructive bile duct stone were randomly divided into open abdomen group （OA, n=35） and combined three endoseopes group （CTE, n=30）. The clinical data of the preparing time before operation, blood loss during operation, and time of recovery were collected. Results There was no significant difference in abdomen cavity drainage time and residual stones between two groups （P〉0.05）. Preoperative time was 1-3 days in OA, 3 of 35 cases in OA died of multiple organ failure syndrome. Preoperative time was 5 7 days in CTE, no case died in CTE. There were shorter postoperative hospital stays[（9.1±4. 3）d vs. （16.7±2.2）d], less postoperative complication[（1.7±0.5）eases vs. （4.0±1.4）easesg, less operative blood loss[（82.7±35.2）ml vs. （203.4±45.1）ml] and less hospital cost in CTE than in OA （P〈0.05）. Conclusions Combined three endoseopes treatment of obstructive bile duct stone is safe and feasible in appropriate patients and has advantages over open operation.

关 键 词：十二指肠镜检查 腹腔镜检查 胆囊切除术 腹腔镜 胆结石 

分 类 号：R686[医药卫生—骨科学]