腹腔镜联合胆道镜再次胆总管探查在老年患者中的应用价值  

Application value of laparoscopy combined with choledochoscopy for common bile duct exploration in elderly patients

作　　者：王怡[1] 司亚卿[1] 陈博文 WANG Yi;SI Ya-qing;CHEN Bo-wen(Department of Hepato-bilio-pancreatic Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院肝胆胰外科,河南郑州450052

出　　处：《腹腔镜外科杂志》2021年第12期924-928,933,共6页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜联合胆道镜胆总管切开探查术治疗老年复发性胆总管结石的安全性与有效性。方法:回顾分析2009年1月至2019年1月收治的265例老年复发性胆总管结石患者的临床资料。按照手术方式分为腹腔镜胆总管探查取石术(LCBDE)组(n=104)与内镜十二指肠乳头括约肌切开术(EST)组(n=161)。经倾向性评分匹配后,两组各纳入66例,比较两组术中情况、术后恢复指标及术后近、远期并发症等。结果:LCBDE组与EST组结石残余率为9.1%与9.1%,中转手术率为3.0%与12.1%,术后近期并发症发生率为12.1%与18.1%,差异均无统计学意义(P>0.05)。术后3 d复查直接胆红素为5.9(5.3~8.1)μmol/L与7.1(4.5~14)μmol/L,住院时间7(6~8)d与8(7~8)d,远期并发症发生率为1.5%与19.7%,胆总管结石复发率为1.5%与16.7%,差异有统计学意义(P<0.05)。两组均无围手术期死亡病例。结论:LCBDE治疗老年复发性胆总管结石是安全、可行的,但术者需具备熟练的腹腔镜操作技术,并做好中转手术的准备。Objective:To explore the safety and effectiveness of laparoscopic common bile duct exploration(LCBDE)combined with choledochoscopy in the treatment of recurrent common bile duct stones in the elderly.Methods:The clinical data of 265 elderly patients with recurrent choledocholithiasis who were diagnosed and treated from Jan.2009 to Jan.2019 were retrospectively analyzed.According to the operation method,they were divided into the LCBDE group(n=104)and endoscopic sphincterotomy(EST)group(n=161).After propensity score matching,each of the two groups included 66 cases.The intraoperative conditions,postoperative recovery,short-term and long-term complications of the two groups were compared.Results:The residual rate of stones in the LCBDE group and the EST group was 9.1%and 9.1%,the rate of conversion to other operation was 3.0%and 12.1%,the incidence of short-term postoperative complications was 12.1%and 18.1%,no significant difference was observed(P>0.05).Three days after surgery,direct bilirubin was 5.9(5.3-8.1)μmol/L and 7.1(4.5-14)μmol/L,hospital stay was 7(6-8)d and 8(7-8)d,the long-term complication rate was 1.5%and 19.7%,and the choledocholithiasis recurrence rate was 1.5%and 16.7%,which showed statistically significant difference(P<0.05).No perioperative death occurred in the two groups.Conclusions:LCBDE is safe and feasible in the treatment of recurrent choledocholithiasis in the elderly.However,it requires the surgeon to have skilled laparoscopic operation techniques and be prepared for conversion to other operation.

关 键 词：胆总管结石 胆总管探查 腹腔镜检查 括约肌切开术 内窥镜 倾向性评分匹配 

分 类 号：R657.4[医药卫生—外科学]