腹腔镜胆囊切除联合术中内镜逆行胰胆管造影治疗 老年胆囊结石合并胆总管结石
| 作者: |
1古广强,
2李波,
1万祎,
1张永川,
1杨闯,
1李华国
1 四川省绵阳市第三人民医院 / 四川省精神卫生中心 肝胆胰外科，四川 绵阳 621000 2 西南医科大学附属医院 肝胆外科，四川 泸州 646000 |
| 通讯: |
古广强
Email: ggq197861@163.com |
| DOI: | 10.3978/.2018.08.004 |
摘要
目的：详细评估腹腔镜胆囊切除术（LC）联合术中经内镜逆行性胰胆管造影术（IOERCP）治疗老年胆囊结石合并胆总管结石的可行性、安全性及效果。
方法：选择 2015 年 5 月—2017 年 10 月绵阳市第三人民医院收治的胆囊结石合并胆总管结石老年患者（≥ 60 岁）共 82 例，用随机数字表的方法随机分成两组，分别行 LC 联合 IOERCP（LC+IOERCP 组， 42 例）与 LC 联合腹腔镜胆总管探查取石（LCBDE）（LC+LCBDE 组，40 例），比较两组相关临床指标。
结果：两组患者的基线资料具有可比性。两组手术时间、术中出血量、中转手术率无统计学差异（均P>0.05），LC+IOERCP 组结石残留率明显低于 LC+LCBDE 组（0 vs. 15.4%，P<0.05）。两组总并发症及各并发症发生率差异均无统计学意义（均 P>0.05）。LC+IOERCP 组住院费用高于 LC+LCBDE 组，住院时间短于 LC+LCBDE 组（均 P<0.05）。
结论：LC 联合 IOERCP 同期治疗老年胆囊结石合并胆总管结石是安全、可行的，具有恢复快、住院时间短及结石残余率低等优点。
关键词：
胆囊结石病；胆总管结石病；胆囊切除术，腹腔镜；胰胆管造影术，内窥镜逆行；老年人
方法：选择 2015 年 5 月—2017 年 10 月绵阳市第三人民医院收治的胆囊结石合并胆总管结石老年患者（≥ 60 岁）共 82 例，用随机数字表的方法随机分成两组，分别行 LC 联合 IOERCP（LC+IOERCP 组， 42 例）与 LC 联合腹腔镜胆总管探查取石（LCBDE）（LC+LCBDE 组，40 例），比较两组相关临床指标。
结果：两组患者的基线资料具有可比性。两组手术时间、术中出血量、中转手术率无统计学差异（均P>0.05），LC+IOERCP 组结石残留率明显低于 LC+LCBDE 组（0 vs. 15.4%，P<0.05）。两组总并发症及各并发症发生率差异均无统计学意义（均 P>0.05）。LC+IOERCP 组住院费用高于 LC+LCBDE 组，住院时间短于 LC+LCBDE 组（均 P<0.05）。
结论：LC 联合 IOERCP 同期治疗老年胆囊结石合并胆总管结石是安全、可行的，具有恢复快、住院时间短及结石残余率低等优点。
Laparoscopic cholecystectomy simultaneously combined with intraoperative endoscopic retrograde cholangiopancreatography in treatment of concomitant cholelithiasis and choledocholithiasis in elderly patients
CorrespondingAuthor:GU Guangqiang Email: ggq197861@163.com
Abstract
Objective: To evaluate the feasibility, safety and clinical effi cacy of laparoscopic cholecystectomy combined with intraoperative endoscopic retrograde cholangiopancreatography (IOERCP) for elderly patients with concomitant cholelithiasis and choledocholithiasis.
Methods: Eighty-two elderly patients (≥60 years of age) with concomitant cholelithiasis and choledocholithiasis admitted in the Third Hospital of Mianyang from May 2015 to October 2017 were enrolled. The patients were randomly assigned to two groups by a random number table, and underwent combined treatment of LC and IOERCP (LC plus IOERCP group, 42 cases) and combined treatment of LC and laparoscopic common bile duct exploration (LCBDE) (LC plus LCBDE group, 40 cases). The main clinical variables between the two groups of patients were compared.
Results: The baseline data of the two groups of patients were comparable. There were no significant differences in operative time, intraoperative blood loss and rate of open conversion between the two groups (all P>0.05). The stone residual rate in LC plus IOERCP group was significantly lower than that in LC plus LCBDE group (0 vs. 15.4%, P<0.05). The overall incidence of postoperative complications and incidence of each specific complication showed no significant difference between the two groups (all P>0.05). The hospitalization cost was increased but the length of postoperative hospital stay was reduced in LC plus IOERCP group compared with LC plus LCBDE group (both P<0.05).
Conclusion: LC simultaneously combined with IOERCP is safe and feasible for elderly patients with concomitant cholelithiasis and choledocholithiasis, with advantages such as rapid postoperative recovery, shortened hospital stay, and lower residual stone rate.
Keywords：
Cholecystolithiasis; Choledocholithiasis; Cholecystectomy
Laparoscopic; Cholangiopancreatography
Endoscopic Retrograde; Aged
Methods: Eighty-two elderly patients (≥60 years of age) with concomitant cholelithiasis and choledocholithiasis admitted in the Third Hospital of Mianyang from May 2015 to October 2017 were enrolled. The patients were randomly assigned to two groups by a random number table, and underwent combined treatment of LC and IOERCP (LC plus IOERCP group, 42 cases) and combined treatment of LC and laparoscopic common bile duct exploration (LCBDE) (LC plus LCBDE group, 40 cases). The main clinical variables between the two groups of patients were compared.
Results: The baseline data of the two groups of patients were comparable. There were no significant differences in operative time, intraoperative blood loss and rate of open conversion between the two groups (all P>0.05). The stone residual rate in LC plus IOERCP group was significantly lower than that in LC plus LCBDE group (0 vs. 15.4%, P<0.05). The overall incidence of postoperative complications and incidence of each specific complication showed no significant difference between the two groups (all P>0.05). The hospitalization cost was increased but the length of postoperative hospital stay was reduced in LC plus IOERCP group compared with LC plus LCBDE group (both P<0.05).
Conclusion: LC simultaneously combined with IOERCP is safe and feasible for elderly patients with concomitant cholelithiasis and choledocholithiasis, with advantages such as rapid postoperative recovery, shortened hospital stay, and lower residual stone rate.