摘要
目的探究腹腔镜经胆囊管胆道探查取石术(LTCBDE)治疗老年肝外胆管结石的疗效及微创优势。方法使用回顾性分析的方法对甘肃省人民医院2018年6月至2024年6月收治的218例老年胆囊结石合并肝外胆管结石患者进行研究,按胆总管管径大小分为正常组(80例)和扩张组(138例),每组分为LTCBDE与LCBDE亚组,比较组间基线特征、手术指标及术后并发症。结果正常胆管组LTCBDE亚组33例均取石成功(7例直接,26例微切开),在手术时间与出血量和结石清除率两组相当,差异无统计学意义(P>0.05),引流时间、住院时间及费用LTCBDE亚组更优(P<0.05)。扩张胆管组LTCBDE亚组成功56例(15例直接,44例微切开),两组手术时间及出血量和结石清除率差异无统计学意义(P>0.05),LTCBDE亚组住院时间及费用更优(P<0.05)。两组LTCBDE亚组胆漏发生率均低于LCBDE组(0%vs.12.8%,1.7%vs.11.4%,均P<0.05)。结论LTCBDE治疗老年肝外胆管结石安全有效,能减少胆漏、缩短住院时间及降低治疗费用。
Objective To explore the efficacy and minimally invasive advantages of laparoscopic transcystic duct biliary exploration and stone removal(LTCBDE)in the treatment of extrahepatic bile duct stones in the elderly.Methods A retrospective analysis was conducted on 218 elderly patients with gallbladder stones combined with extrahepatic bile duct stones admitted to Gansu Provincial People’s Hospital from June 2018 to June 2024.They were divided into the normal group(80 cases)and the dilated group(138 cases)according to the diameter of the common bile duct.Each group was further divided into LTCBDE and LCBDE subgroups.Compare the baseline characteristics,surgical indicators and postoperative complications between groups.Results In the LTCBDE subgroup of the normal bile duct group,stone removal was successful in all 33 cases(7 cases were direct and 26 cases were microincision).The operation time,blood loss and stone clearance rate of the two groups were comparable,and the difference was not statistically significant(P>0.05).The drainage time,hospital stay and cost of the LTCBDE subgroup were better(P<0.05).In the LTCBDE subgroup of the bile duct dilation group,56 cases were successful(15 cases were direct and 44 cases were microincision).There was no statistically significant difference in the operation time,blood loss and stone clearance rate between the two groups(P>0.05).The LTCBDE subgroup had better hospital stay and cost,and the difference was statistically significant(P<0.05).The incidence of bile leakage in both LTCBDE subgroups was lower than that in the LCBDE group(0%vs.12.8%,1.7%vs.11.4%,all P<0.05).Conclusions LTCBDE is safe and effective in the treatment of extrahepatic bile duct stones in the elderly.It can reduce bile leakage,shorten the length of hospital stay and lower the treatment cost.
作者
王小虎
张亚岚
司牟博
蒋智良
王晓鹏
WANG Xiaohu;ZHANG Yalan;SI Mubo;JIANG Zhiliang;WAGN Xiaopeng(Department of General Surgery,Gansu Provincial People’s Hospital,Lanzhou,Gansu 730000,China)
出处
《中国医药指南》
2025年第20期66-69,共4页
Guide of China Medicine
基金
甘肃省联合科研基金项目(23JRRA1547)
院内科研基金项目(21GSSYA-3,22GSSYC-15)
甘肃省科技计划项目(22JR5RA663)。
关键词
腹腔镜
胆道镜
肝外胆管结石
经胆囊管胆道探查取石术
老年
Laparoscopy
Choledochoscopy
Extrahepatic bile duct stones
Stone removal through biliary tract exploration via the gallbladder duct
Old age
