十二指肠镜联合腹腔镜治疗老年胆囊结石合并胆总管结石

Laparoscopy combined with duodenoscopy in treatment of elderly gallbladder and bile duct stones

目的探讨十二指肠镜联合腹腔镜治疗老年胆囊结石合并胆总管结石的疗效和临床作用。方法回顾性分析2008年1月至2010年1月梧州市工人医院收治的胆管结石患者93例,其中49例患者进行十二指肠镜联合腹腔镜(两镜联合)治疗,44例患者进行开腹手术治疗。结果观察组49例患者中,47例手术成功,总住院时间9～19 d,平均13.5 d,围手术期出现并发症4例,其中高淀粉酶血症2例、水肿型胰腺炎2例,随访2个月～3年,无胆道狭窄发生。对照组44例住院时间13～24 d,平均18 d,术后出血3例、胆漏4例,随访2个月～3年,4例患者出现胆管狭窄。观察组的功能恢复时间和平均住院时间均明显少于对照组,两组存在显著性差异(P<0.05);此外观察组的术后患者的残石率和并发症也明显低于对照组,两者同样存在显著性差异(P<0.05)。结论十二指肠镜联合腹腔镜治疗老年胆囊结石合并胆总管结石创伤小、疗效好、预后快,并发症、复发率和残石率低,值得临床推广应用。

Objective To investigate the clinical value of laparoscopy combined with duodenoscopy for the treatment of elderly gallbladder and bile duct stones. Methods A retrospective analysis of 93 cases of patients with gallbladder and bile duct stones in our hospital from January 2008 to January 2010 was taken on, which were devided into two parts of group （including 49 patients received combined endoscopies and 44 patients received open surgery）. Results Totally 47 cases of 49 patients in the observation group was surgical successful, and a total hospital stay was 9 - 19 d, with an average of 13.5 d. Perioperative complications was 4 cases, while 2 cases was hyperamylasemia, and 2 csaes was edem- atous panereatitis, then followed up for 2 months to 3 years, no biliary stricture. In control group of 44 patients hospitali- zation time was 13 -24 d, with an average of 18 d, while postoperative bleeding in 3 cases, bile leakage in 4 cases, fol- lowed up for 2 months to 3 years, 4 patients had bile duct stricture. Functional recovery of the observation group and av- erage length of stay were significantly less than those the control group, there were significant differences between two groups （ P 〈 O. 05 ） ; Also the observation group of patients with postoperative residual stones and complications rate was significantly lower than those the control group, there were significant differences between two groups （ P 〈 0. 05 ）. Conclusions Laparoseopy combined with duodenoscopy for the treatment of elderly gallbladder and bile duct stones are feasible, effective and safe with less trauma and is worthy of using.