老年人胆囊结石合并胆总管结石术式选择探讨(附60例报告)  

Comparison of operative methods for older patients with concomitant cholelithiasis and choledocholithiasis: A report of 60 patients

作　　者：王中魁[1] 赵海鹰[1] 刘金钢[1] 张春菊[1] 吴金龙[1] 

机构地区：[1]中国医科大学附属盛京医院普通外科,辽宁沈阳110004

出　　处：《中国实用外科杂志》2015年第4期448-450,共3页Chinese Journal of Practical Surgery

摘　　要：目的探讨腹腔镜胆囊切除(LC)联合胆总管切开取石术(LCBDE)与LC联合内镜下乳头括约肌切开取石术(EST)治疗老年人胆囊结石合并胆总管结石的疗效。方法回顾性分析2012年1月到2013年5月中国医科大学附属盛京医院普通外科收治的60例老年胆囊结石合并胆总管结石的临床资料。LCBDE组31例,EST组29例。结果 LCBDE组和EST组的住院时间、手术中转率及轻型并发症发生率差异均无统计学意义。LCBDE组重型并发症发生率(0 vs.6.9%,P<0.05)和住院费用(30 063.9±9127.9)元vs.(43 858.3±10 142.6)元,P=0.001)显著低于EST组。结论在老年人胆囊结石合并胆总管结石病人治疗中,LC联合LCBDE较联合EST同样安全有效,且有重型并发症发生率和住院费用低的优势,条件允许时,推荐首选LC联合LCBDE术式。Objective To compare the therapeutic effects of laparoscopic cholecystectomy（LC）plus laparoscopic common bile duct exploration （LCBDE） and LC plus endoscopic sphincterotomy （EST） for older patients with concomitant cholelithiasis and choledocholithiasis. Methods The clinical data of 60 older patients with concomitant gallstones and common bile duct stones admitted from January 2012 to May 2013 in Department of General Surgery, Affiliated Shengjing Hospital, China Medical University were analyzed retrospectively. Among them, 31 patients were in the LCBDE group, and 29 patients in the EST group. Results The total length of hospital stay,the rates of conversion to operation and the morbidity of mild complications had no obvious difference. The morbidity of severe complications （0 vs.6.9%, P〈0.05） and hospitalization expenses [（30 063.9±9127.9） yuan RMB vs.（43 858.3±10 142.6） yuan RMB, P=0.001）] of LCBDE group was significantly lower than those of the EST group. Conclusion For older patients with concomitant cholelithiasis and choledocholithiasis, LC plus LCBDE is safe and effective, compared with LC plus EST, and has a lower morbidity of severe complications and hospitalization expense. LC plus LCBDE is the first choice when without contraindication.

关 键 词：胆囊结石 胆总管结石 内镜下乳头括约肌切开取石术 腹腔镜胆总管切开取石术 老年人 

分 类 号：R6[医药卫生—外科学]