三种外科疗法治疗老年胆囊结石并发肝外胆管结石病人的疗效比较

Comparisons of curative effect of three kinds of surgical treatment in elderly patients with gallstone complicated with extrahepatic bile duct stone

目的探讨3种外科疗法治疗老年胆囊结石并发肝外胆管结石病人的疗效与并发症。方法选取我院2016年7月至2019年6月收治的178例胆囊结石并发肝外胆管结石的老年病人作为研究对象,其中63例采用腹腔镜胆囊切除术联合腹腔镜胆总管探查术(LC+LCBDE),61例采用内镜逆行胰胆管造影联合腹腔镜胆囊切除术(ERCP+LC),54例采用胆囊切除术联合胆总管探查术(OC+OCBDE),对3种术式治疗前后病人的肝功能、手术情况及并发症发生情况进行比较分析。结果3组病人术后5 d AST、ALT以及总胆红素等肝功能指标均较术前明显降低(P<0.05);3组肝功能差异无统计学意义(P>0.05)。OC+OCBDE组手术时间较LC+LCBDE组和ERCP+LC组明显缩短(P<0.05),OC+OCBDE组术中出血量、肛门排气时间以及住院时间均较LC+LCBDE组和ERCP+LC组明显增加(P<0.05)。LC+LCBDE组、ERCP+LC组和OC+OCBDE组术后并发症的发生率分别为7.94%、21.31%和25.93%,组间比较差异具有统计学意义(P<0.05)。结论3种外科疗法治疗胆囊结石并发肝外胆管结石均可有效清除结石,改善肝功能,其中OC+OCBDE术式在缩短手术时间上具有一定的优势,LC+LCBDE术式发生术后并发症的风险最小。

Objective To compare the curative effect and the complications of three kinds of surgical treatment in the elderly patients with gallstone complicated with extrahepatic bile duct stone.Methods A total of 178 cases of elderly patients with gallbladder stones complicated with extrahepatic bile duct stones treated in our hospital from July 2016 to June 2019 were selected.Out of them 63 cases were treated by the laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration(LC+LCBDE),61 cases were treated by endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy(ERCP+LC),and 54 cases were treated by open cholecystectomy combined with open common bile duct exploration(OC+OCBDE).The liver function indexes before and after surgery,operation conditions and the complications after surgery were compared between the three groups.Results The levels of aspartate aminotransferase(AST),alanine aminotransferase(ALT)and total bilirubin in the three groups 5 d after surgery were significantly lower than those before surgery(P<0.05).There were no significant differences in the levels of AST and ALT between the three groups before and 5 d after surgery(P>0.05).The operation time in the OC+OCBDE group was significantly shorter than that in the LC+LCBDE group and the ERCP+LC group(P<0.05).The intraoperative blood loss,anal exhaust time and hospital stay in the OC+OCBDE group were increased significantly than those in the LC+LCBDE group and ERCP+LC group(P<0.05).The incidence rate of postoperative complications in the LC+LCBDE group,ERCP+LC and OC+OCBDE group was 7.94%,21.31%and 25.93%respectively with statistical difference(P<0.05).Conclusions The three surgical treatments for gallbladder stones and extrahepatic bile duct stones can effectively remove the stones and improve the liver function.Among them,OC+OCBDE has certain advantages in shortening the operation time,and LC+LCBDE surgery has minimal risk of postoperative complications.