腹腔镜下经胆囊管汇人部微切开途径行胆道探查术在老年胆总管结石患者中的应用  

Micro-incision of the cystic duct confluence in laparoscopic common bile duct exploration for choledocholithiasis in elderly patients

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

机构地区：[1]北京医院普通外科国家老年医学中心,100730

出　　处：《中华老年医学杂志》2016年第9期960-963,共4页Chinese Journal of Geriatrics

摘　　要：目的对比分析老年患者及非老年患者采用腹腔镜下经胆囊管汇入部微切开途径行胆道探查术（LTM—CBDE）治疗胆总管结石的效果，以评价LTM—CBDE治疗老年患者胆总管结石的安全性及有效性。方法收集2007年3月至2013年12月本院普通外科行LTM—CBDE患者的临床资料128例，按年龄分为老年组（≥65岁）50例，非老年组（〈65岁）78例，进行回顾性分析。分别比较老年组及非老年组患者的术前并发症、美国麻醉医师协会（American Society of Anesthesiologists，ASA）评分、既往腹部手术史、手术时间、术后住院日、中转开腹、术后并发症、残余结石、复发结石和死亡等情况。结果老年组的术前并发症（41例比28例）显著多于非老年组（χ2=26．063，P=0．000），ASA评分（2．5±0．7比1．8±0．6）也显著高于非老年组（t=-6．030，P=0．000）。而在既往腹部手术史、手术时间、术后住院日、术后并发症、复发结石等比较，两组差异无统计学意义（P〉0．05）。所有病例均取净结石，无中转开腹和死亡病例。结论LTM—CBDE治疗老年患者胆总管结石是安全有效的，对于临床情况评估适合的老年胆总管结石患者，LTM—CBDE可作为首选的治疗方法。Objective Common bile duct stones are common in elderly patients. The laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration （LTM-CBDE） is a modified laparoscopic transcystic approach. This study evaluated the safety and efficacy of LTM-CBDE in the elderly （≥65 years） patients with choledocholithiasis and compared the results in the elderly with those in younger patients. Methods In this retrospective analysis, 128 patients underwent LTM-CBDE from March 2007 to December 2023. The patients were divided into two groups：aged ≥65 years （n=50,the elderly group） versus aged 〈65 years （n=78, the younger group）. The preoperative morbidity rate, American Society of Anesthesiologists （ASA） score, previous abdominal operations, operation time, postoperative hospital stay, open conversion rate, postoperative complication rate, residual stone rate,recurrence rate and mortality rate were compared between the both groups. Results The preoperative morbidity （41 vs. 28） and ASA score （2.5±0. 7 vs. 1.8±0.6） were higher in the elderly group than in he younger group （χ2 = 26. 063, t= -6. 030,P = 0. 000, in both）. No significant differences in previous abdominal operations, operation time,postoperative hospital stay, open conversion rate, postoperative complication rate, residual stone rate,recurrence rate and mortality rate （P〉0.05） were found between the two groups from March 2007 to December 2013. Conclusions LTM-CBDE is a safe and effective treatment procedure for elderly patients with choledocholithiasis. For LTM-CBDE-suitable patients, we recommend LTM-CBDE as the treatment of choice.

关 键 词：胆总管结石 胆道外科手术 腹腔镜检查 

分 类 号：R657.42[医药卫生—外科学]