双镜联合微创手术治疗老年胆囊结石并肝外胆管结石的疗效分析

Efficacy analysis of laparoscopic and endoscopic cooperative surgery for minimally invasive treatment of cholecystolithiasis with extrahepatic bile duct stones in the elderly

目的分析双镜联合微创手术[十二指肠镜乳头括约肌切开术(EST)联合腹腔镜胆囊切除术(LC)]治疗老年胆囊结石并肝外胆管结石患者的临床疗效。方法88例老年胆囊结石并肝外胆管结石患者,依据随机数字表法分为研究组与对照组,各44例。对照组给予开腹胆囊切除术、胆道探查及T管引流治疗,研究组使用双镜联合微创手术(EST+LC)治疗。比较两组手术相关指标、术后恢复情况、术后并发症发生情况。结果研究组手术切口长度(4.05±1.19)cm及手术时间(104.28±27.51)min短于对照组的(9.37±2.04)cm、(131.72±28.43)min,术中失血量(38.56±4.35)ml少于对照组的(76.37±17.41)ml,差异有统计学意义(P<0.05)。研究组胃肠功能恢复时间、首次下床活动时间及住院时间分别为(32.58±3.64)h、(21.52±4.64)h、(5.26±1.68)d,均短于对照组的(76.74±14.81)h、(47.27±9.49)h、(10.54±4.17)d,差异有统计学意义(P<0.05)。研究组并发症发生率6.82%低于对照组的22.73%,差异有统计学意义(P<0.05)。结论老年胆囊结石并肝外胆管结石患者采用双镜联合微创手术治疗,可减少手术用时和术中出血量,降低术后并发症发生率,缩短住院时间,利于术后患者早日康复,值得推广应用。

Objective To analyze the clinical efficacy and prognosis of laparoscopic and endoscopic cooperative surgery[endoscopic sphincterotomy(EST)combined with laparoscopic cholecystectomy(LC)]in minimally invasive treatment of cholecystolithiasis with extrahepatic bile duct stones in the elderly.Methods A total of 88 elderly patients with gallbladder stones and extrahepatic bile duct stones were divided into the research group and the control group according to the random numerical table,with 44 cases in each group.The control group was treated with open cholecystectomy,biliary tract exploration and T-tube drainage,and the research group was treated with laparoscopic and duodenoscope combined with minimally invasive surgery(EST+LC).The surgery-related indicators,postoperative recovery,and postoperative complications were compared between the two groups.Results The length of surgical incision(4.05±1.19)cm and the operation time(104.28±27.51)min in the research group were shorter than(9.37±2.04)cm and(131.72±28.43)min in the control group,and the intraoperative blood loss(38.56±4.35)ml was less than(76.37±17.41)ml in the control group.All the differences were statistically significant(P<0.05).The recovery time of gastrointestinal function,first-time off-bed activity time and hospitalization time in the research group were(32.58±3.64)h,(21.52±4.64)h,and(5.26±1.68)d,which were shorter than(76.74±14.81)h,(47.27±9.49)h,(10.54±4.17)d in the control group,and the differences were statistically significant(P<0.05).The incidence of complications 6.82%in the research group was lower than 22.73%in the control group,and the difference was statistically significant(P<0.05).Conclusion In elderly patients with cholecystolithiasis and extrahepatic bile duct stones,laparoscopic and endoscopic cooperative surgery for minimally invasive treatment can reduce the operation time and intraoperative blood loss,reduce the incidence of postoperative complications,shorten the hospitalization time,and facilitate the early recovery of postoperative patients,which is worthy of popularization and application.