腹腔镜和胆道镜治疗高龄胆囊合并胆总管结石分析  

Laparoscope combined with choledochoscope in treating senile patients with gallbladder stones and common bile duct stones

作　　者：徐勇士[1] 刘义武[1] 凌晓明[1] 

机构地区：[1]解放军第一六九医院(湖南师范大学附属湘南医院)肝胆外科,湖南省421002

出　　处：《中华普外科手术学杂志（电子版）》2016年第1期70-72,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜联合纤维胆道镜对高龄胆总管结石合并胆囊结石患者的临床疗效。方法选取2010年2月至2013年2月收治的48例高龄胆总管结石合并胆囊结石患者,按照入院顺序分别纳入胆道镜组及十二指肠镜组,各24例。分别实施腹腔镜胆囊切除(LC)联合胆总管探查取石(LCBDE)及联合内镜下乳头括约肌切开(EST)。数据采用SPSS18.0软件进行分析,并发症发生率采用χ2检验;术中术后计量资料以(x珋±s)表示,采用t检验,以P<0.05有统计学意义。结果胆道镜组手术时间(185.20±52.47)min、术中出血量(35.9±12.8)ml、住院时间(10.26±3.15)d均显著少于十二指肠镜组(t=11.905、13.226、4.198,P<0.05);十二指肠镜组胆管炎发生率为25.0%(6/24),显著高于胆道镜组的4.2%(1/24)(χ2=10.853,P<0.05);差异均有统计学意义。两组患者术后疼痛均处于轻微疼痛范围内,术后下床活动时间、胃肠功能恢复时间、并发症发生率、结石复发率、胆管积气发生率比较差异均未见明显统计学意义(P>0.05)。结论 LC联合LCBDE具有良好的结石清除能力,并可降低术后胆管炎发生率与结石复发率,有利于降低高龄患者手术应激,保证其预后。Objective To investigate the effect of laparoseope combined with eholedochoscope in the treatment of senile patients with common bile duct stones associated with gallbladder stones. Methods Forty-eight senile patients with cholecystolithiasis and choledocholithiasis were treated in our hospital from February 2010 to February 2013. The patients were divided into a eholedochoscope group （24 patients） and a duodenoseope group （24） according to the order of admission. The patients were treated with laparoscopic cholecystectomy （LC） combined with common bile duct exploration （LCBDE） and endoscopic sphincterotomy （EST）. SPSS 18. 0 software was used for data analysis. The incidence of complications was represented as percentage and examined by using the Chi-square test. Intraoperative and postoperative measurement data were represented as mean -＋ SD and examined by using Student＇ s t test. P 〈 0.05 was considered statistically significant. Results The operation time was （ 185.20 ± 52.47 ） rain, intraoperative blood loss （ 35. 9 ± 12. 8 ） ml, and the hospitalization time （ 10. 26 ± 3. 15 ） d in the choledochoscope group, which were significantly less than those in the duodenoscope group （t = 11. 905, 13. 226 and 4. 198 respectively, P 〈 0. 05 ）. The oecmxence of cholangitis in the duodenoscope group was 25.0% （6/24）, which was significantly higher than 4.2% （1/24） in the duodenoscope group X2 = 10. 853, P 〈 0.05 ）. The patients suffered from slight pain postoperatively in both groups. There was no significant difference between the 2 groups in postoperative ambulation time, recovery time of gastrointestinal function, complications, recurrence rate of stones and the incidence rate of bile duct gas （P 〉 0. 05 ）. Conclusion LC combined with LCBDE could successfully remove stones and decrease the recurrence of cholecystolithiasis. This procedure could reduce the postoperative stress of senile patients and improve prognosis.

关 键 词：胆结石 腹腔镜检查 内窥镜检查 

分 类 号：R657.4[医药卫生—外科学]