腹腔镜下胆总管切开取石术与经胆囊管取石术治疗老年胆囊结石伴胆总管结石的效果

Effect of laparoscopic common bile duct stone removal and trans-cystic duct stone removal in the treatment of elderly patients with gallstones combined with common bile duct stones

目的分析腹腔镜下胆总管切开取石术与经胆囊管取石术治疗老年胆囊结石伴胆总管结石的效果及对患者生活质量的影响。方法选取我院2017年3月至2018年3月收治的70例老年胆囊结石伴胆总管结石患者,依据入院先后顺序将其分为对照组(n=35)和试验组(n=35)。对照组给予腹腔镜下胆总管切开取石术治疗,试验组给予腹腔镜下经胆囊管胆总管取石术治疗。比较两组的治疗效果。结果治疗后,两组患者的社会功能、情感角色、心理健康、躯体功能、躯体角色、机体疼痛、生命力及总体健康评分均升高,且试验组高于对照组,差异具有统计学意义(P<0.05)。试验组的手术时间、引流管放置时间、首次排气时间及住院时间均短于对照组,术后补液量及结石数量少于对照组,结石直径小于对照组,差异具有统计学意义(P<0.05)。试验组的并发症总发生率低于对照组,结石清除率高于对照组,差异具有统计学意义(P<0.05)。结论采用腹腔镜下经胆囊管胆总管取石术治疗老年胆囊结石伴胆总管结石,可在改善患者生活质量评分及临床指标的同时减少术后并发症,提高结石清除率,临床借鉴价值较高。

Objective To analyze the effect of laparoscopic common bile duct stone removal and trans-cystic duct stone removal in the treatment of elderly patients with gallstones combined with common bile duct stones and its influence on patients' quality of life. Methods Seventy elderly patients with gallstones combined with common bile duct stones admitted in our hospital from March 2017 to March 2018 were divided into control group (n=35) and experimental group (n=35) according to the order of admission. The control group was treated with laparoscopic common bile duct stone removal, and the experimental group was treated with laparoscopic trans-cystic common bile duct stone removal. The therapeutic effects of the two groups were compared. Results After treatment, the scores of social function, emotional role, mental health, physical function, physical role, body pain, vitality and overall health of the two groups increased, and those of the experimental group were higher than the control group, and the differences were statistically significant (P<0.05). The operation time, drainage tube placement time, first exhaust time and hospitalization time of the experimental group were shorter than those of the control group, the volume of fluid infusion after operation and the number of stones were less than those of the control group, and the stone diameter was smaller than that of the control group, and the differences were statistically significant (P<0.05). The total incidence of complications in the experimental group was lower than that in the control group, and the stone clearance rate was higher than that in the control group, and the differences were statistically significant (P<0.05). Conclusion Laparoscopic trans-cystic common bile duct stone removal can improve the quality of life score and clinical indicators of elderly patients with gallstones combined with common bile duct stones, reduce postoperative complications and increase stone clearance rate. It has a high clinical reference value.