高龄胆总管结石合并胆囊结石患者腹腔镜手术疗效

Efficacy of laparoscopic surgery in the treatment of elderly patients with choledocholithiasis and cholecystolithiasis

目的探讨腹腔镜胆囊切除+胆总管切开探查术(LC+LCBDE)治疗高龄胆总管结石合并胆囊结石患者的疗效及安全性。方法回顾性分析2011年4月至2017年5月复旦大学附属华东医院收治的130例年龄80岁以上高龄胆总管结石合并胆囊结石患者临床资料。患者均签署知情同意书,符合医学伦理学规定。按手术方式分为LC+LCBDE组(腔镜组)和传统开腹组(开腹组)。腔镜组66例,男38例,女28例;平均年龄(84±4)岁。开腹组64例,男30例,女34例;年龄(84±4)岁。两组手术时间、出血量等围手术期指标比较采t检验,并发症发生率比较采用χ~2检验或Fisher确切概率法。结果两组患者手术均成功。腔镜组手术时间、术后首次肛门排气时间、止痛药物使用时间分别为(105±44)min、(2.2±0.8)d、(2.4±1.3)d,明显短于开腹组的(121±39)min、(3.2±1.5)d、(3.2±1.5)d(t=-2.175,-4.072,-3.397;P<0.05)。腔镜组肺部感染发生率为3%(2/66),明显低于开腹组的14%(9/64)(χ~2=5.106,P<0.05)。腹腔镜组术后30 d内死亡1例,开腹组3例,差异无统计学意义(χ~2=0.291,P>0.05)。结论高龄并不是腹腔镜手术的禁忌证,在积极合理的围术期处理下,LC+LCBDE治疗高龄胆总管结石合并胆囊结石患者可行、有效、安全,可有效缩短手术时间,加速康复,减轻术后疼痛,降低术后并发症发生率。

Objective To explore the efficacy and safety of laparoscopic cholecystectomy ＋ laparoscopic common bile duct exploration （LC＋LCBDE） in the treatment of elderly patients with choledocholithiasis and cholecystolithiasis. Methods Clinical data of 130 patients, aged 80 years and above and with choledocholithiasis and cholecystolithiasis, who were admitted in East China Hospital Affiliated to Fudan University from April 2011 to May 2017 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients were divided into LC＋LCBDE group （laparoscopy group） and traditional laparotomy group （laparotomy group） according to different surgical procedure. There were 66 patients in laparoscopy group, including 38 males and 28 females, with an average age of （84±4） years. There were 64 patients in laparotomy group, including 30 males and 34 females, with an average age of （84±4） years. Perioperative indicators such as operation time and amount of bleeding between two groups were compared by t test, and the incidence of complications was compared by Chi-square test or Fisher＇s exact probability test. Results The operations of all the patients were performed successfully. In laparoscopy group, the operation time, postoperative first anus exhaust time and use time of analgesic medication were （105±44） min, （2.2±0.8） d and （2.4±1.3） d, which were significantly shorter than （121±39） min, （3.2±1.5） d and （3.2±1.5） d in laparotomy group （t=-2.175, -4.072, -3.397; P〈0.05）. The incidence of pulmonary infection in laparoscopy group was 3%（2/66）, which was significantly lower than 14%（9/64） in laparotomy group （χ2=5.106, P〈0.05）. 1 case in laparoscopy group and 3 cases in laparotomy group died within 30 d after operation, where no significant difference was observed （χ2=0.291, P〉0.05）. Conclusions Advanced age is not a contraindication for laparoscopic operation. With the positive and reasonable perioperative management, LC＋LCBDE is feasible, effective and safe for the elderly patients with choledocholithiasis and cholecystolithiasis. It can effectively shorten the operation time, accelerate the recovery, reduce postoperative pain and incidence of postoperative complications.