腹腔镜胆囊管汇入部微切开胆道探查术治疗老年胆总管结石  

Laparoscopic transcystic approach with micro-incision of the cystic duct confl uence in common bile duct exploration for choledocholithiasis in elderly patients

作　　者：宋京海[1] 牛小娟[1] 陈剑[1] 贺修文[1] 龙海空[1] 韦军民[1] 

机构地区：[1]北京医院普通外科,100730

出　　处：《中华肝脏外科手术学电子杂志》2016年第4期225-229,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：中央保健科研基金(W2013BJ105)

摘　　要：目的探讨腹腔镜胆囊管汇入部微切开胆道探查术(LTM-CBDE)治疗老年胆总管结石患者的应用价值。方法回顾性分析2007年6月至2015年6月北京医院收治的142例老年胆总管结石患者临床资料。其中男83例,女59例;平均年龄(68±4)岁。患者均签署知情同意书,符合医学伦理学规定。根据不同的手术方式将患者分为3组:LTM-CBDE组62例,腹腔镜胆总管探查术(LCBDE)组49例,开腹胆总管切开探查术(开腹)组31例。3组手术时间、术后住院时间比较采用单因素方差分析和LSD-t检验,率的比较采用χ2检验。结果 3组均取净结石,无结石残留。LTM-CBDE组手术时间(155±11)min明显短于LCBDE组的(166±10)min(LSD-t=-5.043,P<0.05)。LTM-CBDE组术后住院时间(5.7±1.1)d明显短于LCBDE组的(7.3±1.7)d和开腹组的(8.3±1.9)d(LSD-t=-5.448,-7.724;P<0.05)。LTM-CBDE组、LCBDE组、开腹组术后总体并发症发生率分别为18%(11/62)、18%(9/49)、42%(13/31),LTM-CBDE组明显低于开腹组(χ2=7.777,P<0.05)。LTM-CBDE组术后切口感染发生率2%明显低于开腹组的13%(χ2=5.072,P<0.05),无围手术期死亡。随访期间LTM-CBDE组、LCBDE组胆总管结石复发各1例,均经ERCP取石成功。结论 LTM-CBDE治疗老年患者胆总管结石是安全、有效,具有手术时间短、恢复快、并发症少的优势。Objective To investigate the application value of laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration（LTMCBDE） for choledocholithiasis in elderly patients.Methods Clinical data of 142 elderly patients with choledocholithiasis in Beijing Hospital between June 2007 and June 2015 were retrospectively analyzed.There were 83 males and 59 females,aged（68±4） years old on average.The informed consents of all patients were obtained and the local ethical committee approval was received.The patients were divided into three groups according to the different surgical procedures：the LTM-CBDE group（n=62）,laparoscopic common bile duct exploration group（LCBDE group,n=49） and open common bile duct exploration group（open surgery group,n=31）.The operation time and postoperative length of hospital stay among three groups were compared using one way analysis of variance and LSD-t test.The rate was compared using Chi-square test.Results All stones were completely removed in three groups and no residual stone was observed.The operationtime in the LTM-CBDE group was（155±11） min,which was signifi cantly shorter than（166±10） min in the LCBDE group（LSD-t=-5.043,P〈0.05）.The postoperative length of hospital stay in the LTM-CBDE group was（5.7±1.1） d,which was signifi cantly shorter than（7.3±1.7） d in the LCBDE group and（8.3±1.9） d in the open surgery group（LSD-t=-5.448,-7.724;P〈0.05）.The overall incidence of postoperative complications in the LTM-CBDE,LCBDE and open surgery groups was respectively 18%（11/62）,18%（9/49） and 42%（13/31）.The overall incidence of postoperative complications in the LTM-CBDE group was signifi cantly lower than that in the open surgery group（χ2=7.777,P〈0.05）.The incidence of postoperative infection of incision in the LTM-CBDE group was 2%,signifi cantly lower than 13% in the open surgery group（χ2=5.072,P〈0.05）.No death was observed during the perioperative period.One case

关 键 词：胆总管结石 腹腔镜 老年人 围手术期 手术后并发症 

分 类 号：R657.42[医药卫生—外科学]