胆总管结石合并胆囊结石老年患者腹腔镜与传统手术治疗比较

Comparative Study between Laparoscopic Cholecystectomy and Traditional Open Surgery in Elderly Patients with Choledocholithiasis Complicated with Cholecystolithiasis

目的探讨胆总管结石合并胆囊结石老年患者经腹腔镜胆囊切除、胆总管切开探查取石术与传统开腹手术的临床疗效。方法总结分析2012年12月—2015年12月复旦大学附属华东医院普外科97例胆总管结石合并胆囊结石老年患者的临床资料,分为2组:腹腔镜手术组55例,传统开腹手术组42例,比较2组患者手术时间、术中出血量、术后肛门排气时间、术后住院时间、住院费用及术后并发症发生情况。结果 2组患者手术均成功,治愈后出院,无死亡病例。腹腔镜手术组术后出现2例胆总管残余结石,传统开腹手术组术后出现5例胆总管残余结石及3例伤口感染,2组均无胆总管狭窄、胆管炎及腹腔感染者,2组术后并发症发生情况差异无统计学意义(P>0.05)。腹腔镜手术组手术时间(105.6±41.6)min vs(154.9±51.3)min、术中出血量中位数(5 vs 40)mL、术后首次排气时间(2.1±0.9)d vs(4.2±1.6)d、术后住院时间中位数(5 vs 9)d、住院费用(25 660.7±7 699.4)元vs(32 257.3±13 996.1)元,少于传统开腹手术组,差异有统计学意义(P<0.05);结论经腹腔镜胆囊切除、胆总管切开探查取石术治疗老年胆总管结石合并胆囊结石安全、有效,良好的围手术期处理是老年患者手术成功的重要保障。

Objective To discuss the clinical curative effects of laparoscopic cholecystectomy, laparoscopic commonbile duct exploration （LCBDE） and traditional open surgery on elderly patients with choledocholithiasis complicated with chol-ecystolithiasis. Methods A retrospective analysis was made to the clinical data of 97 elderly patients with choledocholithiasiscomplicated with cholecystolithiasis hospitalized in Department of Surgery, Huadong Hospital affiliated to Fudan Universityduring the period from December 2012 to December 2015; the 97 patients were divided into 2 groups： laparoscopy group（/i=55） and traditional open surgery group （n =42）; a comparative study was made between the 2 groups in operation lastingtime, bleeding volume in operation, the first time of fart after operation, hospitalization duration, hospitalization cost andthe occurrence of complications after operation. Results All the operations in both groups were successful and the patientswere discharged with good recovery, no death occurred; residual stones in common bile duct were found in 2 cases in laparo-scopy group and 5 cases in traditional open surgery group, incision infection occurred in 3 cases in traditional open surgerygroup, no cases occurred common bile duct stenosis, cholangitis and abdominal infection in both groups. Between the 2groups,the operation lasting time was （105.6 ±41.6） minutes vs （154.9 ±51.3） minutes,the bleeding volume in operationwas 5 mL vs 40 mL, first time of fart after operation was （2.1 ±0.9） days vs （4.2± 1.6） days; the median hospitalizationduration was 5 days vs 9 days, hospitalization cost was RMB （25 660.7 ±7 699.4） yuan vs RMB （32 257.3 ±13 996.1）yuan,the differences between the 2 groups were of statistical significance （P〈0.05）. there existed no statistical differencein the occurrence of complications after operation between the 2 groups （P〉 0.05）. Conclusions Laparoscopic cholecystectomyand laparoscopic common bile duct exploration （LCBDE） are safe and effective for elderly patients with choledocholithiasiscomplicated with cholecystolithiasis, good perioperative management is important for successful operation in elderly patients.