腹腔镜胆总管切开取石与ERCP治疗老年胆管结石的疗效比较

Comparison of clinical effects between laparoscopic common bile duct exploration(LCBDE)and endoscopic retrograde cholangiopancreatography(ERCP)for elderly patients with choledocholithiasis

目的探讨腹腔镜胆总管切开取石与ERCP治疗75岁以上老年人的疗效.方法回顾分析我院2018年1月至2020年12月收治的符合入选标准的高龄(年龄≥75岁)胆总管结石患者113例,其中81例行腹腔镜胆总管切开取石(腹腔镜组,A组),32例行ERCP术(ERCP组,B组).比较两组的术前基线资料、术后住院时间、住院费用、术后并发症、结石复发率等资料.结果两组术前基线资料比较,腹腔镜组术前合并胆囊结石病例比例高于ERCP组,差异有统计学意义(P≤0.05),其余数据比较差异无统计学意义(P>0.05).腹腔镜组腹腔引流管引流时间、术后住院时间、住院费用明显优于ERCP组,差异有统计学意义(P≤0.05).而在术后总并发症发生率、胆汁漏、肺部感染、结石残留、结石复发等方面,两组差异无统计学意义(P>0.05).结论LCBDE术能一并解决胆囊结石及胆总管结石,且术后住院时间、费用等方面明显优于ERCP组,所以在腹腔镜技术已成熟的中心,即便是对于高龄患者仍应以LCBDE术为首选术式.

Objective To compare the clinical effects of elderly patients with choledocholithiasis treated by laparoscopic common bile duct exploration(LCBDE)and endoscopic retrograde cholangiopancreatography(ERCP).Methods The clinical data of 113 elderly patients with choledocholithiasis from Jan.2018 to Dec.2020 were collected and analyzed retrospectively.According to the surgery way,it was divided into two group,patients in group A(n=81)received LCBDE and others in group B(n=32)received ERCP.Comparative studies on preoperative baseline data,postoperative hospital stay,total hospitalization costs,postoperative complications,and the recurrence rate of stones were made.Results The proportion of patients with gallstones before surgery in group A was higher than that in group B(P≤0.05),while there was no statistically significant difference in other data(P>0.05).Group A was superior to Group B on total hospitalization costs and postoperative hospital stay(P≤0.05).And there were no differences between the two groups on the postoperative complications and recurrence rate of stones(P>0.05).Conclusions LCBDE can solve both cholecystolithiasis and choledocholithiasis,and the postoperative hospitalization time and cost are significantly better than ERCP group.Therefore,LCBDE should still be the first choice in the centers with mature laparoscopic techniques,even for elderly patients.