腹腔镜与十二指肠镜联合治疗老年肝外胆管结石的临床应用

Study of duodenal endoscopy combined with laparoscopy in treatment of extrahepatic bile duct stone and cholecystolithiasis in old patients

①目的探讨腹腔镜与十二指肠镜联合治疗老年肝外胆管结石患者的临床应用价值。②方法选择罹患胆囊结石合并胆总管结石的老年患者56例,其中28例前瞻性地应用十二指肠镜下逆行胰胆管造影(ERCP)及十二指肠乳头切开术(EST)与腹腔镜胆囊切除术(LC)联合治疗,另28例作为对照组,行传统胆囊切除术及胆总管切开加T管引流术。比较两组胆总管内径、胆总管结石最大径、胆总管结石数目、手术总时间、术后胃肠道功能恢复时间、术后并发症的发生率、总住院天数、住院总费用。③结果两组患者在胆总管内径、胆总管结石最大径和胆总管结石数目方面无明显差异;ERCP+EST+LC组较传统手术组手术时间明显缩短(P<0.05),术后胃肠道功能恢复明显加快(P<0.011),术后并发症明显少(P<0.01),住院天数明显缩短(P<0.01),住院费用有明显增加(P<0.01)。④结论十二指肠镜和腹腔镜联合治疗胆囊结石合并胆总管结石具有疗效好、痛苦少、创伤小、恢复快、住院时间短等优点,有利于老年患者耐受手术。

Objective To evaluate duodenal endoscopy combined with laparoscopy treatment for choledocholithiasis and cholelithiasis in old patients. Methods 56 old patients suffered from choledocholithiasis and cholelithiasis were divided into two groups. 28 patients in ERCP ＋ EST ＋ LC group were treated with endoscopic retrograde cholangiopancreatography （ERCP） , endoscopic sphincterotomy （EST） and laparoscopic cholecystectomy（ LC）, while 28 patients in control group were treated with open cholecys- tectomy and choledochotomy with T tube drainage. Common bile duct diameter, stone size, stone number in common bile duct, op- eration time, gastrointestinal function recovery time, complication rate, hospitalization time and cost were observed and analyzed. Results There was no statistical difference in common bile duct diameterand stone size and numbers. Compared with control group, operation time, gastrointestinal function recovery time, complication rate and hospitalization time were decreased （ P 〈 0.05, P 〈 0.01 ） while the hospitalization cost were increased （ P 〈 0.01 ）. Conclusion The combined application of ERCP/EST and LC is ef-fective and feasible in the treatment of cholangitis with choledocholithiasis and cholelithiasis in old patients. It has so many advanta ges such as better effect, less trauma, rapider recovery;and shorter length of hospitalization.