胆道镜联合腹腔镜胆总管探查术治疗高龄患者胆总管结石的效果

Efficacy of combined cholangioscopy and laparoscopic exploration of the common bile duct for the treatment of common duct stones in elderly patients (≥ 80 years old)

目的 探讨胆道镜联合腹腔镜胆总管探查术治疗高龄(≥80岁)患者的胆总管结石的安全性及可行性。方法 回顾性分析2017年3月至2022年10月安徽医科大学附属巢湖医院收治的40例高龄(≥80岁,观察组)和40例(<80岁,对照组)胆总管结石患者行胆道镜联合腹腔镜胆总管探查治疗的病历资料(共80例)。比较2组腹腔镜手术成功率、一次性结石清除率、手术时间、住院时间、住院费用、术后下床活动时间、术后进食时间、术后拔除腹腔引流管时间、术后有无进入重症监护室(ICU)的例数等,同时对2组术后总并发症包括胆漏、结石残留、肺部感染、合并下肢血栓及压疮等情况进行比较。结果 2组均无死亡病例,观察组39例完成手术,1例中转开腹,对照组38例完成手术,2例中转开腹。2组的手术成功率、一次性结石清除率、术后进入ICU例数、术后拔除腹腔引流管时间、手术时间及总并发症相比,差异无统计学意义(P>0.05);总住院时间及住院总费用相比,观察组有明显的劣势;术后进食时间及下床时间相比,观察组明显长于对照组。结论 在充分做好围术期处理,调整好内科基础疾病,纠正不良手术影响因素的情况下,胆道镜联合腹腔镜胆总管探查术治疗高龄(≥80岁)患者的胆总管结石是安全可行的。

Objective To explore the safety and feasibility of cholangioscopy combined with laparoscopic common bile duct exploration(LCBDE)for the treatment of common duct stones in elderly patients(≥80 years old).Methods Retrospective analysis of medical records of 40 elderly(≥80 years old,observation group)and 40 patients(<80 years old,control group)with common bile duct stones who underwent choledochoscopy combined with laparoscopic common bile duct exploration treatment(a total of 80 cases)in the Affiliated Chaohu Hospital of Anhui Medical University from March 2017 to October 2022.Compare the success rate of laparoscopic surgery,one-time stone removal rate,surgery time,hospital stay,hospitalization costs,postoperative time to get out of bed,postoperative eating time,postoperative time to remove abdominal drainage tubes,and the number of cases with or without entering the intensive care unit(ICU)after surgery between two groups.At the same time,compare the total postoperative complications of the two groups,including bile leakage,stone residue,pulmonary infection,combined lower limb thrombosis,and pressure ulcers.Results There were no deaths in both groups,39 patients in observation group finished the surgery,1 was transferred to laparotomy,38 patients in control group finished the surgery,and 2 were transferred to laparotomy.There was no significant difference between the two groups in surgical success rate,one-time stone clearance rate,number of patients admitted to the ICU after surgery,postoperative drainage tube withdrawal time,surgical duration and total complications(P>0.05).Compared with the length of hospital stay and total hospital expenses,the observation group had a significant disadvantage(P<0.05).Conclusions The cholangioscopy combined with laparoscopic common bile duct exploration(LCBDE)is safe and feasible for the treatment of common duct stones in elderly patients(≥80 years of age)with adequate perioperative management,adjustment of medical underlying disease,and correction of adverse surgical influence factors.