十二指肠镜联合腹腔镜手术治疗老年胆囊结石合并胆总管结石124例

Duodenoscopy and laparoscopic cholecystectomy in the treatment of cholecyslithiasis complicated with choledocholithiasis in 124 aged patients

目的探讨十二指肠镜联合腹腔镜续贯治疗老年患者胆囊结石合并肝外胆管结石的疗效。方法回顾分析2010年1月至12月246例老年患者(年龄大于等于60岁)胆囊结石合并肝外胆管结石的临床资料,按手术方式的不同分为微创组和传统手术组。微创组(n=124)采用十二指肠镜下内镜乳头括约肌切开术(EST)取石再行腹腔镜胆囊切除术(LC),传统手术组(n=122)采用传统开腹胆囊切除术胆总管切开取石T管引流术,对比两组住院时间、并发症和结肠功能恢复时间等。结果微创组与传统手术组比较,住院时间短、并发症低和术后结肠功能恢复时间短,差异均有明显的统计学意义(P<0.01);两组手术时间无统计学差异(P>0.05)。结论十二指肠镜联合腹腔镜续贯治疗老年胆囊结石合并肝外胆管结石具有微创、安全、疗效良好等优点。

Objective To evaluate the efficacy of duodenoscopy and laparoscopic cholecystectomy in the treatment of cholecyslithiasis complicated with choledoeholithiasis and to discuss its clinical significance. Methods The clinical data of 246 aged patients with cholecyslithiasis complicated with eholedocholithiasis （ age ≥ 60 years） from January 2010 to December 2010 were retrospectively analyzed. The patients were divided into the minimally invasive group （n = 124） and the conventional surgery group （n = 122 ）. The patients in the minimally invasive group were underwent duodenoscopy, endoscopic sphincterotomy （EST） and laparoscopic choleeystectomy （LC） while those in the conventional surgery group （n = 122） were experienced traditional open eholecystectomy, eholedocholithotomy and T-tube drainage. The hospital stay, complications and recovery time of the colon function were compared between the two groups. Results The hospital stay was shorter in the minimally invasive group compared with that in the conventional therapy group ,P 〈 0.01. The complications were fewer in the minimally invasive group compared with that in the conventional therapy group, P 〈 0.01. The colon functional recovery time was shorter in in the minimally invasive group compared with that in the conventional therapy group, after the surgery,P 〈 0.01. There was no significant difference in operative time between the two groups （ P 〉 0.05 ）. Conclusion consecutive treatment of cholecyslithiasis complicated with choledocholithiasis by duodenoscopy and laparoscopic cholecystectomy is minimally invasive, safe and effective.