选择性Ⅰ期腹腔镜胆囊切除联合内镜逆行胆胰管造影在老年胆囊结石合并胆总管结石中的临床应用

doi:10.3969/j.issn.1005-6483.2019.08.010

摘要/Abstract

摘要： 目的探讨选择性I期腹腔镜胆囊切除（LC）联合内镜逆行胆胰管造影（ERCP）在老年胆囊结石合并胆总管结石病人中的应用价值。方法胆囊结石合并胆总管结石病人60例，其中观察组30例，为老年人，对照组30例，为中、青年病人，均行术前肝功能、MRCP检查，Ⅰ期行LC+ERCP，分析两组病人手术时间、术中出血量、住院时间及费用等，并调查病人满意度。结果观察组与对照组的手术时间分别为（84.2±9.9）分钟和（81.2±14.1）分钟，术中出血量分别为（50.5±13.0）ml和（50.2±8.3）ml，术后下床活动时间分别为（10.7±1.4）小时和（10.2±1.5）小时，住院费用分别为（29322±854.8）元和（29233±878.9）元，两者比较差异均无统计学意义（P>0.05）；观察组与对照组的住院时间分别为（7.2±1.1）天和（6.5±0.8）天，差异有统计学意义（P<0.05）；两组术中术后均未出现出血、穿孔、胆漏、肠漏、胆管损伤等严重并发症，并发症发生率比较差异无统计学意义（P>0.05）；观察组病人满意度（96.23±2.70）分，对照组为（96.33±2.63）分，差异无统计学意义（P>0.05）。结论老年胆囊结石合并胆总管结石，选取合适的病人，Ⅰ期行LC+ERCP治疗是一种安全可靠的术式。

关键词: 腹腔镜, 胆胰管造影术, 内窥镜, 老年, 胆石症

Abstract: Objective To explore the application value and prospect of selective Ⅰ phased Laparoscopic Cholecystectomy（LC） combined with Endoscopic Retrograde Cholangiopancreatography（ERCP） of the elderly patients in the patients with cholecystolithiasis combined with choledocholithiasis.Methods 60 cases of elderly patients with cholecystolithiasis combined with choledocholithiasis were collected in the two hospitals.The liver function and MRCP examination were performed before the operation，and patients were selected with normal liver enzyme，no jaundice and no abdominal pain as an observation group（30 cases），Ⅰ phased LC+ERCP，and 30 cases of middle-aged patients and young patients with same diseases were collected as the control group in the same period，the two groups of patients in the operation time，intraoperative bleeding，hospital care time and cost and other aspects of the situation were compared，and the satisfaction of the patients were investigated.Results The operative time of the observation group and the control group was（84.2±9.9）min and（81.2±14.1）min，respectively，and the intraoperative blood loss was（50.5±13.0）ml and（50.2±8.3）ml，respectively.The postoperative time of getting out of bed was（10.7±1.4）h and（10.2±1.5）h，respectively，and the hospitalization cost was（29322±854.8）yuan and（29233±878.9）yuan，respectively，which all showed no statistical significance（P>0.05）.The length of stay in the observation group and control group was（7.2±1.1）d and（6.5±0.8）d，respectively，with statistically significant differences（P<0.05）.No serious complications such as bleeding，perforation，bile leakage，intestinal leakage and bile duct injury occurred during and after operation in the two groups，there was no statistically significant difference in the incidence of complications（P>0.05）.Patients' satisfaction score was（96.23±2.70）in the observation group and（96.33±2.63）in the control group，the difference was not statistically significant（P>0.05）.Conclusion In the elderly patients with cholecystolithiasis combined with choledocholithiasis，the appropriate patients were selected.Ⅰ phased LC+ERCP treatment is a safe and reliable operation.Although the number of days in hospital is prolonged，it is still of high clinical value and application prospect.It is worth further promotion.

Key words: laparoscopy, cholangiopancreatography, endoscopy, the elderly, cholelithiasis

中图分类号:

李伟, 辛国军. 选择性Ⅰ期腹腔镜胆囊切除联合内镜逆行胆胰管造影在老年胆囊结石合并胆总管结石中的临床应用[J]. 临床外科杂志, 2019, 27(8): 661-663.

LI Wei, XIN Guojun.. The research on clinical application value of selective Ⅰphased LC + ERCP with elderly patients in cholecystolithiasis combined with choledocholithiasis[J]. JOURNAL OF CLINICAL SURGERY, 2019, 27(8): 661-663.

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