ERCP/EST联合LC与LCBDE联合LC治疗高龄胆囊并胆总管结石的临床疗效及预后分析  

Clinical efficacy of LC plus LCBDE and ERCP/EST followed by LC in treatment of concomitant gallbladder stones and common bile duct stones in the elderly patients

作　　者：郑晨[1] 黄新[1] 李万林[1] 曾文[1] 申亚伟[1] Zheng Chen;Huang Xin;Li Wanlin;Zeng Wen;Shen Yawei(First Department of General Surgery,Xi＇an Central Hospital,Xi＇an,Shaanxi 710003,China)

机构地区：[1]西安市中心医院普外一科,陕西710003

出　　处：《中华普外科手术学杂志（电子版）》2018年第6期529-531,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的比较内镜逆行胰胆管造影/内镜下括约肌切开取石术(ERCP/EST)联合腹腔镜胆囊切除术(LC)与腹腔镜胆总管探查取石(LCBDE)联合LC治疗高龄胆囊并胆总管结石的临床疗效。方法回顾性分析2015年11月至2017年10月80例高龄胆囊并胆总管结石患者的临床资料,依据术式不同分为ERCP/EST+LC组和LCBDE+LC组各40例。用统计学软件SPSS19. 0处理和分析,手术效果相关指标等采用(x珋±s)描述计量资料,运用独立t检验;结石残留率、并发症发生率等采用卡方检验,以P <0. 05表示差异有统计学意义。结果 LCBDE+LC组与ERCP/EST+LC组的手术成功率(95. 0%比90. 0%)和术后并发症发生率(7. 5%比10. 0%)相比,差异均无统计学意义(P>0. 05); ERCP/EST+LC组住院费用和住院时间明显高于LCBDE+LC组(P <0. 05)。两组患者结石残留率对比差异无统计学意义(2. 5%比5. 0%)(P> 0. 05)。两组患者术后随访3～24个月,两组患者术后感染率、结石复发率比较,差异无统计学意义(P> 0. 05)。结论两种术式均安全有效,建议临床实践中根据老年患者的实际病情加以选择应用。Objective To compare the clinical efficacy of LC plus LCBDE and ERCP/EST followed by LC in treatment of concomitant gallbladder stones and common bile duct stones in the elderly patients. Methods The clinical data of 80 patients of concomitant gallbladder stones and common bile duct stones treated with minimally invasive surgical treatment in our hospital from November 2015 to October 2017, were retrospectively analyzed. Of the patients, 40 cases received LC plus LCBDE （LCBDE＋LC group）, and 40 cases underwent ERCP followed by LC （ERCP/EST＋LC group）. Research data was analyzed by SPSS 19.0 statistical software, the clinical data were shown as （x±s） , and compared with independent t test, the incidence of complication such as the residual stone rate and postoperative complication rate were compared with χ 2 test, and P 〈0.05 was regarded to be statistically significant. Results In LC＋LCBDE group versus ERCP/EST＋LC group, the surgical success rate （95.0% vs. 90.0%） and incidence of postoperative complications （7.5% vs. 10.0%） showed no significant difference（ P 〉0.05）, but the hospitalization cost was significantly decreased （P 〈0.05） and length of hospital stay was significantly shortened in the LC＋LCBDE group （ P 〈0.05）. The residual stone rate showed no significant difference between the two groups（ P 〉0.05）. Both groups were followed up for 3 to 24 months; the incidence of stone recurrence and biliary tract infections showed no significant difference between the two groups. Conclusion The two types of operation are both safe and effective. It is suggested that the clinical practice should be selected and applied in accordance with the actual condition of the elderly patients.

关 键 词：胆结石 胆总管结石 胆囊切除术 腹腔镜 胰胆管造影术 内窥镜逆行 老年人 80以上 

分 类 号：R657.4[医药卫生—外科学]