腹腔镜联合胆管镜在老年人胆总管结石中的应用体会  

Application of laparoscope combined with choledochoscope in treating common bile stones of elderly patients

作　　者：胡磊[1] 侯亚峰[1] 叶显道[1] 李仁宝[1] HU Lei;HOU Yafeng;YE Xiandao;LI Renbao(Department of Hepatobiliary Surgery,The People＇s Hospital of Tongling,Tongling,Anhui 244000,China)

机构地区：[1]铜陵市人民医院肝胆外科,安徽铜陵244000

出　　处：《安徽医药》2018年第10期1956-1958,共3页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探索腹腔镜联合胆管镜在老年人胆总管结石的应用。方法从2014年2月至2016年12月,通过超声、上腹部CT或MRI等影像学检查收集56例老年胆总管结石患者,分别进行腔镜胆总管探查(LCDE)和开腹胆总管探查(OCDE),通过查看麻醉记录单、住院清单及医嘱单获得患者的住院费用、饮食时间、术后住院时间,同时术后观察患者并发症发生情况并进行分析。结果 LCDE组的手术时间较OCDE组稍长[(115±25)min比(148±32)min,t=4.223,P<0.05],但是LCDE组的饮食时间以及术后住院时间较OCDE组缩短(t=8.152,t=4.557,P<0.05)。同时,LCDE组的住院费用接近OCDE组(t=0.520,P>0.05)。LCDE组因手术操作困难发生中转2例(2/29),胆漏1例(1/27),术后残留结石1例(1/27),重症肺炎1例(1/27),无切口感染;OCDE组发生切口感染1例(1/27),无胆漏、重症肺炎及残留结石,两组并发症发生率差异无统计学意义(P>0.05)。结论老年人胆总管结石通过腹腔镜联合胆管镜治疗是安全的,值得推广,但应进行充分的围手术期处理,才能有效防止相关并发症的发生。Objective To explore the application of laparoscope combined with choledochoscope in treating common bile stones of elderly patients. Methods From February 2014 to December 2016,56 cases of senile choledocholithiasis were colleCTed by ultrasound,upper abdominal CT or MRI. Open choledoch exploration（ OCDE） and laparoscope choledoch exploration（ LCDE） were performed respeCTively,and the hospitalization expenses,time to take food and postoperative hospital stay was obtained by checking the anesthesia record,hospitalization list and doCTor＇s order sheet,and postoperative complications were observed and analyzed. Results The operation time of the LCDE group was slightly longer than that of OCDE group [（ 115 ± 25） min vs.（ 148 ± 32） min,t = 4. 223,P〈0. 05],but the time to take food and postoperative hospital stay in LCDE group were shorter than those in OCDE group（ t = 8. 152,t = 4. 557,P〈0. 05）. Meanwhile,the hospitalization expenses in LCDE group was nearly the same as that in OCDE group（ t = 0. 520,P〉0. 05）.In LCDE group,2 cases converted to laparotomy due to the difficulty of operation（ 2/29）,and there were 1 case of bile leakage（ 1/27）,1 case of postoperative residual stones（ 1/27）,and 1 case of severe pneumonia（ 1/27）,yet no wound infeCTion occurred. In OCDE group,there was 1 case of wound infeCTion,yet no pneumonia,bile leakage and residual stones occurred. There was no obvious difference in the incidence of complications between the two group（ P〉0. 05）. Conclusions Laparoscopy combined with choledochoscopy in the treatment of choledocholithiasis is safe and worthy of promotion in elderly patients,but adequate perioperative preparations should be managed to effeCTively prevent the occurrence of complications.

关 键 词：胆总管结石 腹腔镜检查 胆总管造口术 老年人 

分 类 号：R657.4[医药卫生—外科学]