目的 观察内镜十二指肠乳头括约肌切开取石术后联合腹腔镜下胆囊切除术(EST+LC)与腹腔镜胆囊切除联合胆总管探查取石术(LC+ LCBDE)治疗老年性胆囊并胆总管结石患者的临床疗效,探讨老年性胆囊结石并胆总管结石患者的治疗策略.方法 回顾性分析我院2013年1月至2016年6月收治的符合入选标准的158例胆总管结石并胆囊结石患者临床资料.观察组82例患者于腹膜炎控制后行EST术,术后3天行LC术;对照组76例患者于腹膜炎控制后行LC+ LCBDE术.比较两组患者术前血淀粉酶、手术时间、术中出血量、术后肛门排气时间、总住院时间、总住院费用和术后并发症总发生率.结果 观察组与对照组患者的手术总时间分别为(95.0 ±7.0) min、(125.0±18.0)min,对照组明显延长(P<0.05);总住院费用分别为(39515.0 ±4135.0)元、(28 287.0 ±2 254.0)元,观察组明显增多(P<0.05);术后并发症分别为5例(6.1%)、10例(13.2%),对照组明显增多(P<0.05).两组患者术前血淀粉酶水平分别为(97.6±48.5)IU/L、(131.4±68.7) IU/L;术中出血量分别为(35.7±8.5)ml、(31.8±7.3)ml;术后肛门排气时间分别为(1.7±0.5)d、(1.9±0.4)d,总住院时间分别为(16.3±2.8)d、(15.2±3.7)d,差异均无统计学意义(均P>0.05).结论 EST术后3天行LC术治疗老年性胆囊并胆总管结石患者是有效、安全的,具有创伤小、手术时间短、恢复快、并发症少等优点,是值得推广的临床治疗老年性患者胆囊并胆总管结石的手术方式.
Objective To study the clinical results of patients with gallbladder stones and common bile duct stones treated either by laparoscopic cholecystectomy followed by endoscopic sphincterotomy (EST + LC) or laparoscopic cholecystectomy + common bile duct exploration (LC + LCBDE) in the elderly patients.Methods A retrospective study was conducted on 96 patients who had common bile duct and gallbladder stones treated from January 2012 to January 2016.The patients were divided into the control group and the observation group.46 patients were in the observation group who underwent LC three days after EST,while the remaining patients were in the control group who underwent LC and LCBDE.The serum amylase levels before LC,operation time,intraoperation bleeding volume,postoperative time to first flatus,total hospitalization stay and total hospitalization costs and incidences of postoperative complication were compared.Results The total operation time was (95.0 ±7.0) minutes and (125.0 ± 18.0) minutes,respectively,(P<0.05).The total costs in the two group were (39515.0 ±4 135.0) yuan and (28287.0 ± 2 254.0) yuan (P < 0.05),respectively.Postoperative complications were observed in 5 (6.1%) and 10 (13.2%) patients (P < 0.05),respectively.The preoperative serum amylase levels were (97.6 ± 48.5) IU/L and (131.4 ± 68.7) IU/L,respectively.The blood loss was (35.7 ± 8.5) ml and (31.8 ± 7.3) ml,respectively.The postoperative time to first flatus was (1.7 ± 0.5) days and (1.9 ± 0.4) days,respectively.The total hospitalization stay was (16.3 ±2.8) days and (15.2 ±3.7) days.There were no significantly differences (P > 0.05).Conclusions LC carried out on day 3 after EST to treat elderly patients with cholecystolithiasis and choledocholithiasis was safe and efficacious and the treatment had the advantages of minimal trauma,short operative time,rapid recovery and low complication rates.This should be recommended in clinical practice.