腹腔镜胆囊切除术联合腹腔镜胆总管探查术治疗老年胆囊结石合并胆总管结石的疗效及安全性分析

The clinical efficacy and safety of laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration in the treatment of elderly patients with cholecystolithiasis complicated with choledocholithiasis

目的评估腹腔镜胆囊切除术(Laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查术(Laparoscopic common bile duct exploration,LCBDE)治疗老年胆囊结石合并胆总管结石(Cholecystolithiasis complicated with choledocholithiasis,CCWC)的疗效及安全性。方法选择2014年6月~2016年6月本院收治的CCWC患者93例作为研究对象,根据随机数字表法将其分为LC+LCBDE组46例和对照组47例,对照组患者给予传统开腹胆总管探查手术治疗,记录手术过程中各项指标以及住院情况并进行比较。结果 LC+LCBDE组术中出血量、手术时间、术后肛门排气时间、住院时间以及住院费用显著少于对照组,生存质量评分显著高于对照组,比较具有统计学差异(t值依次为3.239、3.692、3.437、3.019、2.468、2.671,均P<0.05);LC+LCBDE组手术并发症发生率(2例)4.35%、结石复发率(3例)6.52%、胆管积气发生率(2例)4.35%、胆管炎发生率(4例)8.70%分别显著低于对照组(8例)17.02%、(5例)10.64%、(4例)8.51%、(7例)14.89%,比较具有统计学差异(χ2值依次为4.261、3.582、3.184、2.954,均P<0.05)。结论 LC+LCBDE治疗CCWC疗效可靠,在提高患者生存质量的同时住院时间短、费用少,手术并发症发生率、结石复发率、胆管积气发生率、胆管炎发生率低,值得在临床进行推广应用。

Objective To evaluate the efficacy and safety of LC ＋ LCBDE in the treatment of elderly patients with CCWC.Methods A total of 93 patients with CCWC in our hosipital form Jun 2014 to Jun 2016 were selected as the research object,randomly divided into LC ＋ LCBDE group（ 46 cases） and control group group（ 47 cases）,patients in the control group were treated with conventional common bile duct exploration,patients in the LC ＋ LCBDE group were treated with LC ＋ LCBDE,recorded and compared the indicators of the operation process and the hospitalization. Results The amount of bleeding,operation time,postoperative anal exhaust time,hospitalization time and hospitalization expenses of LC ＋ LCBDE group were significantly lower than those of control group,the score of quality of life was significantly higher than that of control group,the difference were statistically significant（ the value of t were 3. 239,3. 692,3. 437,3. 019,2. 468,2. 671 respectively,P 0. 05）; The incidence of postoperative complications 2 cases（ 4. 35%）,recurrence rate（ 3 cases） 6. 52%,incidence of bile duct gas accumulation in 2 cases（ 4. 35%） and cholangitis occurred in4 cases（ 8. 70%） in LC ＋ LCBDE group were significantly lower than those in the control group 8 cases（ 17. 02%）,5 cases（ 10. 64%）,4 cases（ 8. 51%）,7 cases（ 14. 89%）,the difference were statistically significant（ the value of χ2 were 4. 261,3. 582,3. 184,2. 954 respectively,P 0. 05）. Conclusion LC ＋ LCBDE for the treatment of CCWC is reliable curative effect,while improving the quality of life of patients,the hospital stay is short and the cost is low,the incidence of postoperative complications,recurrence rate pneumobilia incidence and incidence of cholangitis are low,it is worth in clinical application.