老年胆囊结石并胆总管结石病人经内镜下逆行胰胆管造影术后序贯腹腔镜胆囊切除术治疗手术时机的研究

doi:10.3969/j.issn.1005-6483.2021.06.017

摘要/Abstract

摘要： 目的：探讨老年胆囊结石并胆总管结石病人经内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography，ERCP)后不同时间点行腹腔镜胆囊切除术(laparoscopic cholecystectomy，LC)治疗的安全性及临床疗效。方法：2015年1月～2020年6月行ERCP后序贯LC治疗的老年(年龄≥60岁)胆囊结石并胆总管结石病人99例，依照ERCP术后不同时间点行LC分为两组，试验组48例，ERCP术后1天内行LC；对照组51例，ERCP术后2~7天内行LC。电话随访术后3个月内并发症情况。结果：试验组总住院时间(13.0±4.6)天，总住院费用(38172.5±12448.9)元，对照组分别为(15.1±4.4)天和(42535.4±8814.6)元，两组比较差异均有统计学意义(P＜0.05)。两组LC中转开腹率、术后总并发症、LC术后住院时间、LC术中出血量、LC手术时间，差异均无统计学意义(P＞0.05)。结论：老年胆囊结石并胆总管结石ERCP术后1天内行LC并未增加手术难度及术后并发症，但缩短了住院时间,经济且安全。

关键词: 老年, 胆总管结石, 内镜下逆行胰胆管造影, 胆囊切除

Abstract: Objective：To explore the safety and efficacy of laparoscopic cholecystectomy in different time points after endoscopic retrograde cholangiopancreatography in elderly patients with cholecystolithiasis and choledocholithiasis.Methods：99 elderly patients(≥60 years old) with cholecystolithiasis and choledocholithiasis treated by sequential LC after ERCP in the Department of Hepatobiliary and Pancreatic surgery in our hospital from January 2015 to June 2020 were analyzed.According to different time points after ERCP,LC was divided into experimental group(within 1 day after ERCP) and control group(within 27 days after ERCP).The complications were followed up by telephone within 3 months after operation.Results：After analysis,the difference between the experimental group and the control group in the total length of hospitalization［(13.0±4.6)d vs(15.1±4.4)d］ and total hospitalization expenses［(38 172.5±12 448.9) vs(42 535.4±8 814.6)］ was statistically significant(P＜0.05).However,there was no significant difference in the conversion rate of LC to laparotomy,the total postoperative complications,the length of hospital stay after LC,the amount of blood loss during LC and the time of LC operation between the two groups(P>0.05).Conclusion：For elderly patients with cholecystolithiasis and choledocholithiasis,LC within 1 day after ERCP does not increase the difficulty of operation and postoperative complications,but shortens the hospitalization time,and it is economical and safe at the same time.

Key words: elderly, choledocholithiasis, endoscopic retrograde cholangiopancreatography, cholecystectomy

王磊, 刘康伟, 段玉灵等. 老年胆囊结石并胆总管结石病人经内镜下逆行胰胆管造影术后序贯腹腔镜胆囊切除术治疗手术时机的研究[J]. 临床外科杂志, 2021, 29(6): 559-561.

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