两种不同微创方法治疗老年胆囊结石合并胆总管结石的疗效对比

A comparative analysis of two different minimally invasive methods in the treatment of cholecystolithiasis with common bile duct stones in the elderly

目的分析不同微创方法治疗老年胆囊结石合并胆总管结石的临床疗效。方法从2017年5月-2018年5月在我院治疗的老年胆囊结石合并胆总管结石患者中选择72例进行研究,随机分为2组,对照组36例,给予内镜下Oddi括约肌切开取石术与腹腔镜胆囊切除术(EST+LC)联合治疗;观察组36例,给予腹腔镜胆总管探查取石术与腹腔镜胆囊切除术(LCBDE+LC)联合治疗。比较2组的手术情况和临床疗效。结果观察组的手术时间和下床活动时间均长于对照组,但住院时间短于对照组,治疗费用低于对照组,有显著性差异(P<0.05);2组的术中出血量比较差异无统计学意义(P>0.05)。观察组的手术成功率为91.67%、中转开腹率为5.56%、一次结石清除率为83.33%、并发症发生率为8.33%,对照组分别为88.89%,5.56%,80.56%,8.33%,均无明显差异(P>0.05)。结论EST+LC和LCBDE+LC治疗老年胆囊结石合并胆总管结石,手术成功率高、结石清除率高、术后并发症少,且疗效相当,临床上应根据患者具体情况合理选择治疗方案。

Objective To analyze two different minimally invasive methods for the treatment of cholecystolithiasis with common bile duct stones in the elderly and compare their curative effects.Methods From May 2017 to May 2018,72 elderly patients with cholecystolithiasis and choledocholithiasis were selected and studied.They were randomly divided into two groups.36 patients in the control group were given endoscopic sphincterotomy combined with laparoscopic cholecystectomy(EST+LC).36 patients in the observation group were given laparoscopic choledocholithotomy combined with laparoscopic cholecystectomy.Treatment(LCBDE+LC),compared the two groups of surgical indications and clinical efficacy.Results The operation time and the time of getting out of bed in the observation group were more than those in the control group,but the hospitalization time was shorter than that in the control group and the treatment cost was lower than that in the control group.There was a significant difference between the two groups(P<0.05).there was no significant difference in the amount of intraoperative bleeding between the two groups(P>0.05).The success rate of operation was 91.67%,the conversion rate to open surgery was 5.56%,the stone clearance rate was 83.33%,and the complication rate was 8.33%in the observation group and 88.89%,5.56%,80.56%and 8.33%in the control group,respectively.There was no significant difference between the two groups(P>0.05).Conclusion EST+LC and LCBDE+LC are effective methods for the treatment of cholecystolithiasis complicated with common bile duct stones in the elderly.the success rate of operation is high,the stone clearance rate is high,and the complications after operation are few,and the curative effect is comparable.