腹腔镜一步法治疗高龄胆囊结石合并胆总管结石的临床疗效观察  

Clinical Observation of Laparoscopic One-Step Treatment of Gallbladder Stones Combined with Common Bile Duct Stones in Elderly Patients

作　　者：刘炯 彭乐[1] 马伟 江斌 Liu Jiong;Peng Le;Ma Wei(Diagnosis and Treatment Center for Hepatobiliary,Taihe Hospital Affiliated Hospital of Hubei University of Medicine,Shiyan,Hubei 444200,China)

机构地区：[1]湖北医药学院附属十堰市太和医院肝胆胰外科诊疗中心,湖北十堰444200

出　　处：《四川医学》2025年第2期172-177,共6页Sichuan Medical Journal

摘　　要：目的 探究腹腔镜一步法治疗高龄胆囊结石合并胆总管结石的临床疗效。方法 选取2020年2月至2023年2月我院收治的68例高龄胆囊结石合并胆总管结石患者,研究组35例行腹腔镜一步法治疗,对照组33例行内镜逆行胰胆管造影取石联合腹腔镜胆囊切除术。比较两组手术相关指标、手术成功率、残余结石、术后临床症状、炎性因子、疼痛程度、术后近远期并发症。结果 与对照组比较,研究组手术时间、术后住院时间、排气时间、肠鸣音恢复时间、住院费用均减少,差异有统计学意义(P<0.05)。两组取石成功率、残余结石率比较,差异无统计学意义(P>0.05)。与对照组(6.06%)比较,研究组腹痛(25.71%)发生率增加,差异有统计学意义(P<0.05),但发热、呕吐、腹胀等发生率与对照组比较,差异无统计学意义(P>0.05)。与对照组比较,研究组RBP水平升高,TNF-α、IL-6、IL-8水平下降,差异有统计学意义(P<0.05)。与对照组比较,研究组疼痛程度得分下降,差异有统计学意义(P<0.05)。与对照组比较,研究组近期胆汁漏发生率更高,胰腺炎、心脑血管疾病发生率及远期胆管炎发生率更低,差异有统计学意义(P<0.05)。结论 高龄胆囊结石合并胆总管结石患者采用腹腔镜一步法治疗安全、经济、有效,尤其在手术时间、术后恢复、住院费用、炎性反应、疼痛程度、术后近远期并发症方面具有明显优势。Objective To explore the clinical efficacy of one-stage laparoscopic management of gallbladder and common bile duct stones in elderly patients.Methods Sixty-eight elderly patients with gallbladder and common bile duct stones admitted to our hospital from February 2020 to February 2023 were selected,of which 35 patients who underwent one-stage laparoscopic management were set as study group,and 33 patients who underwent endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy were enrolled as control group.Then the surgical indicators,surgical success rate,residual stones,stone recurrence rate,postoperative clinical symptoms,inflammatory factors,pain degree,and short-term and long-term postoperative complications were compared between the two groups.Results Compared with control group,study group had shorter duration of surgery,length of stay,exhaust time and intestinal sound recovery time,as well as lower hospitalization cost,with statistical difference(P<0.05).The success rate of stone removal and residual stone rate yielded no statistical difference rate between the two groups(P>0.05).The incidence of abdominal pain was 25.71%in study group,which was higher than 6.06%in control group(P<0.05),and no statistical difference was found in the incidence of fever,vomiting and abdominal distension between two groups(P>0.05).The levels of retinol binding protein(RBP)in study group were higher than those in control group,and tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-8(IL-8)were lower than those of control group(P<0.05).Study group scored lower on pain rating scale than that of control group(P<0.05).The short-term incidence rate of bile leakage in study group was higher than that in control group,and the incidence of pancreatitis,cardiovascular and cerebrovascular diseases was lower than that in control group(P<0.05).The long-term incidence rate of cholangitis in study group was lower than that in control group(P<0.05).Conclusion One-stage laparoscopic management of gallbla

关 键 词：腹腔镜一步法 高龄 胆囊结石 胆总管结石 结石复发 并发症 

分 类 号：R657.4[医药卫生—外科学]