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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2019, Vol. 13 ›› Issue (06) : 640 -642. doi: 10.3877/cma.j.issn.1674-3946.2019.06.030.

所属专题： 文献；

论著

快速康复外科联合腹腔镜胆总管探查取石术治疗高龄胆总管结石的疗效评价
王春1, 崔玉辉1,†(), 李明杰1, 邓一迪1   
  1. 1. 710016　西安，长安医院普外科
  • 收稿日期:2018-12-02 出版日期:2019-12-26
  • 通信作者: 崔玉辉

Efficacy of fast track surgery combined with 1aparoscopic common bile duct exploration in the treatment of elderly patients with choledocholithiasis

Chun Wang1, Yuhui Cui1,†(), Mingjie Li1, Yidi Deng1   

  1. 1. Department of General Surgery, Chang’an Hospital, Xi’an 710016, China
  • Received:2018-12-02 Published:2019-12-26
  • Corresponding author: Yuhui Cui
  • About author:
    Corresponding author: Cui Yuhui, Email:
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引用本文：

王春, 崔玉辉, 李明杰, 邓一迪. 快速康复外科联合腹腔镜胆总管探查取石术治疗高龄胆总管结石的疗效评价[J/OL]. 中华普外科手术学杂志(电子版), 2019, 13(06): 640-642.

Chun Wang, Yuhui Cui, Mingjie Li, Yidi Deng. Efficacy of fast track surgery combined with 1aparoscopic common bile duct exploration in the treatment of elderly patients with choledocholithiasis[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2019, 13(06): 640-642.

目的

探讨快速康复外科(FTS)理念联合腹腔镜胆总管探查取石术(LCBDE)治疗高龄患者胆总管结石的临床疗效。

方法

对2014年1月至2017年12月收治并拟行腹腔镜胆总管探查取石术(LCBDE)95例患者进行前瞻性研究，运用excel随机数表法分成FTS联合LCBDE组(FTS组)47例，常规LCBDE组(常规组)48例；应用SPSS22.0软件对临床数据进行分析，术后恢复情况及营养情况等以(±s)形式表示，采用独立t检验；术后并发症采用χ2检验；以P<0.05表示差异有统计学意义。

结果

FTS组术后进食时间、术后下床活动时间、肛门排气时间、排便时间、住院天数和住院费用方面均显著少于常规组(P<0.05)；术后不良反应及并发症总发生率6.4%明显低于常规组16.6%(P<0.05)；术后血清前白蛋白明显高于常规组(P<0.05)。

结论

快速康复外科联合腹腔镜胆总管探查取石术疗效确切，具有术后恢复快，并发症少等优势，值得在临床中推广使用。

关键词: 胆总管结石, 腹腔镜检查, 康复, 治疗结果
Objective

To investigate the clinical efficacy of fast track surgery(FTS) combined with 1aparoscopic common bile duct exploration (LCBDE) in the treatment of choledocholithiasis among elderly patients.

Methods

95 patients treated with LCBDE in our hospital From January 2014 to December 2017 were collected and analyzed retrospectively. These patients were divided into two groups randomly by Excel random number table method, one was FTS combined with LCBDE group (FTS group, 47 cases), the other was routine LCBDE group (conventional group, 48 cases). All clinical data were statistically analyzed by SPSS22.0 software. The postoperative recovery and nutritional status were expressed in the form of mean±standard deviation, t test was used for comparison between groups, and the counting data of postoperative complications were examined by chi square test. The difference was statistically significant in terms of P<0.05.

Results

Compare with the conventional group, the time of food intake, getting out of bed, anal exhaust, defecation and length of stay and the hospital expenses were significantly lower in the FTS group (P<0.05); The total incidence of postoperative adverse reactions and complications was significantly lower than those in the conventional group (6.4% vs. 16.6%, P<0.05) ; Postoperative serum prealbumin was significantly higher than that of conventional group (P<0.05).

Conclusion

The effect of fast track surgery combined with 1aparoscopic common bile duct exploration is effective and quicker recovery, less complications, less stress response and so on, which is worth popularizing in clinic.

Key words: Choledocholithiasis, Laparoscopy, Rehabilitation, Treatment outcome
表1 95例高龄胆总管结石患者围术期不同干预措施两组患者的临床基线数据比较(±s)
组别 例数 男/女 年龄(岁) BMI(kg/m2) 并发症(例)
A/B/C/D
常规组 48 24/24 70.9±5.9 22.6±2.3 12/14/11/5
FTS组 47 21/26 71.1±5.2 22.9±2.4 10/15/9/3
χ2/t值 ? 0.27 0.18 0.62 0.19/0.09/0.20/0.50
P值 ? 0.60 0.86 0.54 0.67/0.77/0.65/0.48
表2 95例高龄胆总管结石患者围术期不同干预措施两组患者术后恢复情况比较(±s)
组别 进食时间(h) 下床活动时间(h) 肛门排气时间(h) 排便时间(h)
FTS组 22.0±2.1 10.2±1.1 19.6±2.0 49.9±4.7
常规组 34.9±10.0 14.2±3.6 30.2±5.5 62.3±5.5
t值 8.658 7.291 12.431 11.802
P值 0.000 0.000 0.000 0.000
组别 住院天数(d) 住院费用(万元) 血清PA(mg/L)
术前 术后3 d
FTS组 6.9±1.0 0.9±0.1 267.6±50.1 246.5±52.3a
常规组 9.3±1.6 1.2±0.1 268.1±53.9 210.6±60.0a
t值 8.746 10.848 0.047 3.106
P值 0.000 0.000 0.963 0.003
表3 95例高龄胆总管结石患者围术期不同干预措施两组术后并发症发生率比较[例(%)]
组别 例数 腹胀 切口感染 胆瘘 腹膜炎 肺部感染 总发生率
FTS组 47 1 0 1 0 0 2(6.4)
常规组 48 3 1 1 1 2 8(16.6)
χ2值 ? ? ? ? ? ? 4.209
P值 ? ? ? ? ? ? 0.040
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