腹腔镜联合纤维胆道镜治疗老年胆总管结石对患者术后疼痛及胃肠功能恢复的影响

The Effect of Laparoscopy Combined with Fiber Choledochoscope in the Treatment of Elderly Choledocholithiasis on Postoperative Pain and Gastrointestinal Function Recovery

目的探讨腹腔镜联合纤维胆道镜治疗老年胆总管结石对患者术后疼痛、胃肠功能恢复的影响.方法选择该院2017年4月—2020年10月收治的老年胆总管结石患者80例,以随机数表法分组为对照组(n=40)与试验组(n=40).对照组采用开腹手术取石,试验组采用腹腔镜联合纤维胆道镜取石.比较两组的手术相关指标、术后疼痛与胃肠功能恢复情况以及并发症发生率.结果两组的手术时间比较,差异无统计学意义(P>0.05);试验组的术中出血量(36.31±5.92)mL、住院时间(7.02±1.10)d均小于对照组的(118.42±18.94)mL、(9.11±1.38)d,组间差异有统计学意义(P<0.05).试验组术后的VAS评分小于对照组,疼痛持续时间、肠鸣音恢复时间、排气时间、排便时间均短于对照组,组间差异有统计学意义(P<0.05).两组的并发症发生率比较,试验组的2.50%低于对照组,差异有统计学意义(P<0.05).结论腹腔镜联合纤维胆道镜治疗老年胆总管结石较开腹取石治疗效果更好,对患者损伤小,术后疼痛轻微且持续时间短,胃肠功能恢复快,并发症风险低,有利于患者康复,值得推广.

Objective To explore the effect of laparoscopy combined with fiber choledochoscope for elderly choledocholithiasis on postoperative pain and recovery of gastrointestinal function.Methods Selected 80 elderly patients with common bile duct stones admitted to this hospital from April 2017 to October 2020,and divided them into the control group(n=40)and the test group(n=40)by the random number table method.The control group used laparotomy to remove stones,and the test group used laparoscopy combined with fiber choledochoscope to remove stones.The surgical indicators,postoperative pain and gastrointestinal function recovery,and the incidence of complications were compared between the two groups.Results There was no statistically significant difference in the operation time between the two groups(P>0.05);the intraoperative blood loss(36.31±5.92)mL and hospitalization time(7.02±1.10)d of the test group were less than those of the control group(118.42±18.94)mL,(9.11±1.38)d,and the difference between the groups was statistically significant(P<0.05).The postoperative VAS score of the experimental group was lower than that of the control group,and the pain duration,bowel sound recovery time,exhaust time,and defecation time were shorter than those of the control group,and the difference between the groups was statistically significant(P<0.05).Comparing the incidence of complications,2.50%in the experimental group was lower than control group,and the difference was statistically significant(P<0.05).Conclusion Laparoscopy combined with fiber choledochoscope is more effective than laparotomy for the treatment of choledocholithiasis in the elderly.It has less damage to the patient,mild postoperative pain and short duration,fast recovery of gastrointestinal function,low risk of complications,and is beneficial to patient recovery.It is worth promoting.