高龄合并上腹部手术史患者行腹腔镜胆总管探查及T管引流术的临床疗效

Clinical effects of laparoscopic common bile duct exploration and T-tube drainage in elderly patients with a history of upper abdominal operation

目的:探讨高龄合并上腹部手术史患者行腹腔镜胆总管探查及T管引流术(laparoscopic common bile duct exploration and T-tube drainage,LCBDE-TD)的可行性、有效性和安全性,总结其手术方法与技巧.方法:回顾性分析2012-01/2013-12 28例65岁以上高龄合并上腹部手术史的胆总管结石患者,其中15例行LCBDE-TD,13例行开腹胆总管探查及T管引流术(open common bile duct exploration and T-tube drainage,OCBDE-TD).对比两种手术方式的手术时间、术中失血量、术后通气时间、术后住院天数等指标.结果:28例手术均获成功.腹腔镜组与开腹组平均手术时间分别为120.4 min±40.6 min、164.4 min±47.9 min(P=0.014<0.05);术中出血量分别为62.0mL±33.4 mL、110.8 mL±52.8 mL(P=0.006<0.05);术后通气时间分别为3.9 d±1.0 d、4.9 d±1.1 d(P=0.022<0.05);术后住院天数分别为8.5 d±2.2 d和13.4 d±5.0 d(P=0.002<0.05);两组差异均具有统计学意义.结论:高龄合并上腹部手术史患者行LCBDE-TD,具有手术时间短、术中出血少、术后胃肠功能恢复快、住院时间短等优点,值得推广.

AIM： To assess the feasibility, effectiveness, and safety of laparoscopic common bile duct exploration and T-tube drainage（LCBDE-TD） in elderly patients with a history of upper abdominal operation, and summarize the surgical methods and skills.METHODS： The clinical data for 28 elderly patients（60 years） with a history of upper abdominal operation from January 2012 to December 2013 were retrospectively analyzed. Of these patients, 15 underwent LCBDE-TD and 13 underwent open common bile duct exploration and T-tube drainage（OCBDE-TD）. The average time of operation, intro-operative blood loss, time to recovery of gastrointestinal function and postoperative hospitalization time were compared between the two groups.RESULTS： All the patients were operated successfully. The operative time for the laparoscopy group and open group was, respectively, 120.4 min ± 40.6 min and 164.4 min ± 47.9 min（P = 0.014 0.05）. The intro-operative blood loss was 62.0 mL ± 33.4 mL and 110.8 mL ± 52.8 mL, respectively（P = 0.006 0.05）. The time to postoperative recovery of gastrointestinal function was 3.9 d ± 1.0 d and 4.9 d ± 1.1 d, respectively（P = 0.022 0.05）.The postoperative hospitalization time was 8.5 d ± 2.2 d and 13.4 d ± 5.0 d, respectively（P = 0.002 0.05）.CONCLUSION： LCBDE-TD for elderly patients with a history of upper abdominal operation has the advantages of shorter operative time, less intra-operative blood loss, faster recovery of gastrointestinal function, and shorter hospitalization than open surgery.