腹腔镜再次手术治疗高龄胆管结石的临床分析  

Clinical Analysis of Laparoscopic Reoperation for Choledocholithiasis in Elderly Patients

作　　者：何贤禄 He Xianlu(Department of General Surgery, The Second Affiliated Hospital of Chengdu Medical College·Nuclear Industry 416 Hospital, Chengdu 610051, China)

机构地区：[1]成都医学院第二附属医院·核工业四一六医院肝胆胰血管外科,成都610051

出　　处：《成都医学院学报》2022年第1期79-82,共4页Journal of Chengdu Medical College

摘　　要：目的评估腹腔镜再次手术治疗高龄(≥70岁)胆管结石的安全性、有效性及适应证。方法回顾性分析2012年3月至2021年8月于成都医学院第二附属医院·核工业四一六医院行再次手术治疗的88例高龄胆管结石患者临床资料,根据手术方式分为腔镜组和开腹组,每组各44例,比较两组患者的一般资料、手术时间、术中出血量、切口长度、术后镇痛时间、肛门排气时间、术后并发症(胆漏、胆道狭窄、胆道残石及切口感染)发生率及术后住院时间。结果两组一般资料比较差异无统计学意义(P>0.05),开腹组手术均顺利完成,腹腔镜组有1例因出血中转开腹。腹腔镜组相比于开腹组,手术时间、术中出血量、手术切口长度更优,术后肛门排气时间、术后镇痛时间、术后住院时间更短,术后伤口感染率低于开腹组,差异有统计学意义(P<0.05)。两组术后胆漏、胆道狭窄、残余结石发生率比较差异均无统计学意义(P>0.05)。结论腹腔镜再次胆道手术治疗高龄胆总管结石安全、有效,具有手术时间更短、出血少、恢复快、切口感染率低、住院时间短等优势。Objective To evaluate the safety,efficacy and indications of laparoscopic reoperation in the treatment of choledocholithiasis in elderly patients(≥70 years old).Methods The clinical data of 88 elderly patients with choledocholithiasis who underwent reoperation in the Second Affiliated Hospital of Chengdu Medical College from March 2012 to August 2021 were analyzed retrospectively.The patients were divided into laparoscopy group(n=44)and laparotomy group(n=44)according to the surgical approaches.The general data,duration of operation,intraoperative blood loss,length of incision,duration of postoperative analgesia,anal exhaust time,incidence of postoperative complications(bile leakage,biliary stenosis,retained choledocholithiasis and incision infection),and postoperative hospital stay were compared between the two groups.Results There was no significant difference in general data between the two groups(P>0.05).All operations in the laparotomy group were successfully completed,while 1 case in the laparoscopy group was converted to laparotomy due to intraoperative hemorrhage.Compared with the laparotomy group,the laparoscopy group had shorter duration of operation,less intraoperative blood loss,shorter length of incision,earlier anal exhaust,reduced postoperative analgesia time,shorter postoperative hospital stay,and lower incidence of postoperative incision infection,and the differences were statistically significant(P<0.05).There was no significant difference in the incidence of other postoperative complications such as bile leakag,biliary stenosis and retained choledocholithiasis(P>0.05).Conclusion Laparoscopic reoperation is safe and effective in the treatment of choledocholithiasis in elderly patients.It has the advantages of shorter duration of operation,less intraoperative blood loss,faster recovery,lower incidence of postoperative incision infection,and shorter hospital stay.

关 键 词：腹腔镜 高龄 胆总管结石 

分 类 号：R657.4[医药卫生—外科学]