双镜联合同期手术治疗老年胆囊结石并胆总管结石的疗效

doi:10.3877/cma.j.issn.1674-3946.2021.03.027

目的

探讨腹腔镜联合十二指肠镜同期(IO-ERCP/EST+LC)和腹腔镜联合术中胆道镜同期(LC/LCBDE+IOC)治疗老年胆囊结石并胆总管结石的疗效和安全性差异。

方法

回顾性分析2017年10月至2020年10月收治的80例老年胆囊结石并胆总管结石患者资料，根据手术方案不同，将其分为A组(IO-ERCP/EST+LC)和B组(LC/LCBDE+IOC)每组40例，数据分析采用SPSS 21.0进行统计处理，术中术后指标、肝功能指标等计量资料以(±s)表示，独立t检验；术后并发症、结石清除率、结石残留率等计数资料以χ²检验比较，P<0.05差异有统计学意义。

结果

A组手术时间短于B组，差异有统计学意义(P<0.05)；两组结石清除率、结石残留率、术后出血、穿孔、胆漏、胰腺炎、胆管炎等术后并发症发生情况比较，差异均无统计学意义(P>0.05)；两组患者术前术后3 d，胆红素、ALT、AST、ALP肝功能水平比较，差异无统计学意义(P>0.05); A组术后排气时间短于B组，住院时间和住院费用均大于B组，差异均有统计学意义(P<0.05)。

结论

IO-ERCP/EST+LC治疗方案手术时间短、术后恢复快，但是住院费用相对较高，临床上可根据患者具体情况做出最合理最优的方案选择。

关键词: 胆囊结石病, 胆总管结石, 腹腔镜, 十二指肠镜, 胆道镜

Objective

To compare the efficacy and safety of laparoscopic combined with duodenoscope (IO-ERCP/EST+ LC) and laparoscopic combined with intraoperative choledochoscope (LC/LCBDE+ IOC) in the treatment of gallstones and choledocholithiasis in the elderly.

Methods

From October 2017 to October 2020, clinical data of 80 elderly patients with gallstones and choledocholithiasis were analyzed retrospectively. According to different surgical plans, 40 cases were divided into the group A (IO-ERCP/EST+ LC), and 40 cases were divided into group B (LC/LCBDE+ IOC). Statistical software SPSS21.0 were used for data analysis. Measurement data such as intraoperative and postoperative indicators, liver function indicators and other measurement data were expressed as (±s), and were examined by independent t test. Chi-square test were performed for the analysis of postoperative complications, stones Counting data such as clearance rate and stone residual rate. A P value of <0.05 was considered statistically significant difference.

Results

The operation time in group A were significantly shorter than that of group B (P<0.05). There were no statistically significant difference between groups in terms of postoperative complications such as stone removal rate, residual stone rate, postoperative bleeding, perforation, bile leakage, pancreatitis and cholangitis (P>0.05). There were no statistically significant difference between groups in terms of liver function levels of bilirubin, ALT, AST, and ALPbefore and after the operation (P>0.05); The postoperative exhaust time of group A was shorter than that of group B, and the hospitalization time and cost of group A were higher than that of group B, with statistically significant differences (P<0.05).

Conclusions

The IO-ERCP/EST+ LC treatment has a shorter operation time and quicker postoperative recovery, however the hospitalization cost is relatively high. Clinically, the most reasonable and optimal program choice should be made according to the specific conditions of the patient.

Key words: Cholecystolithiasis, Choledocholithiasis, Laparoscopes, Duodenoscopes, Choledochoscopy

表1 80例老年胆囊结石并胆总管结石患者不同术式两组患者一般资料比较(±s)

组别	例数	年龄(岁)	性别	发热(例)	胆红素μmol/L
组别	例数	年龄(岁)	男/女	发热(例)	胆红素μmol/L
A组	40	68.9±5.1	16/24	8	22.6±6.1
B组	40	67.6±5.6	14/26	10	23.5±5.9
统计值		1.064	0.213	0.287	0.509
P值		0.145	0.644	0.592	0.306

表1 80例老年胆囊结石并胆总管结石患者不同术式两组患者一般资料比较(±s)

组别	例数	年龄(岁)	性别	发热(例)	胆红素μmol/L
组别	例数	年龄(岁)	男/女	发热(例)	胆红素μmol/L
A组	40	68.9±5.1	16/24	8	22.6±6.1
B组	40	67.6±5.6	14/26	10	23.5±5.9
统计值		1.064	0.213	0.287	0.509
P值		0.145	0.644	0.592	0.306

表2 80例老年胆囊结石并胆总管结石患者不同术式两组手术完成情况比较(±s)

组别	例数	结石清除率[例(%)]	结石残留率[例(%)]	术中出血量(ml)	手术时间(min)
A组	40	39(97.5)	1(2.5)	45.3±6.1	105.5±23.6
B组	40	38(95.0)	2(5.0)	47.3±6.7	130.3±25.3
t/χ²		0.346	1.476	4.492
P值		0.556	0.072	<0.001

表2 80例老年胆囊结石并胆总管结石患者不同术式两组手术完成情况比较(±s)

组别	例数	结石清除率[例(%)]	结石残留率[例(%)]	术中出血量(ml)	手术时间(min)
A组	40	39(97.5)	1(2.5)	45.3±6.1	105.5±23.6
B组	40	38(95.0)	2(5.0)	47.3±6.7	130.3±25.3
t/χ²		0.346	1.476	4.492
P值		0.556	0.072	<0.001

表3 80例老年胆囊结石并胆总管结石患者不同术式两组术后并发症率比较[例(%)]

组别	例数	出血	穿孔	胆漏	胰腺炎	胆管炎	总发生率(%)
A组	40	0(0.0)	0(0.0)	0(0.0)	2(5.0)	0(0.0)	5.0
B组	40	0(0.0)	0(0.0)	2(5.0)	0(0.0)	2(5.0)	10.0
χ²值							0.721
P值							0.396

表3 80例老年胆囊结石并胆总管结石患者不同术式两组术后并发症率比较[例(%)]

组别	例数	出血	穿孔	胆漏	胰腺炎	胆管炎	总发生率(%)
A组	40	0(0.0)	0(0.0)	0(0.0)	2(5.0)	0(0.0)	5.0
B组	40	0(0.0)	0(0.0)	2(5.0)	0(0.0)	2(5.0)	10.0
χ²值							0.721
P值							0.396

表4 80例老年胆囊结石并胆总管结石患者不同术式两组术后肝功能指标比较(±s)

组别	时间	胆红素(μmol/L)	ALT(u/L)	AST(u/L)	ALP(u/L)
A组	术前	20.3±2.3	139.2±18.3	121.0±21.0	139.6±9.3
	术后	19.3±2.3	75.9±14.0	22.3±3.1	110.3±20.3
B组	术前	20.4±2.5	137.6±17.6	120.5±20.3	137.5±8.1
	术后	18.9±2.3^a	76.9±15.3^a	23.0±3.1^a	113.3±21.7^a

表4 80例老年胆囊结石并胆总管结石患者不同术式两组术后肝功能指标比较(±s)

组别	时间	胆红素(μmol/L)	ALT(u/L)	AST(u/L)	ALP(u/L)
A组	术前	20.3±2.3	139.2±18.3	121.0±21.0	139.6±9.3
	术后	19.3±2.3	75.9±14.0	22.3±3.1	110.3±20.3
B组	术前	20.4±2.5	137.6±17.6	120.5±20.3	137.5±8.1
	术后	18.9±2.3^a	76.9±15.3^a	23.0±3.1^a	113.3±21.7^a

表5 80例老年胆囊结石并胆总管结石患者不同术式两组术后恢复情况比较(±s)

组别	例数	术后排气时间(h)	住院时间(d)	住院费用(元)
A组	40	16.3±3.1	20.9±4.1	5.3±1.2
B组	40	20.1±3.4	13.0±4.6	3.6±1.1
t值		5.166	7.193	62.079
P值		<0.001	<0.001	<0.001

表5 80例老年胆囊结石并胆总管结石患者不同术式两组术后恢复情况比较(±s)

组别	例数	术后排气时间(h)	住院时间(d)	住院费用(元)
A组	40	16.3±3.1	20.9±4.1	5.3±1.2
B组	40	20.1±3.4	13.0±4.6	3.6±1.1
t值		5.166	7.193	62.079
P值		<0.001	<0.001	<0.001

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Clinical analysis of the efficacy and safety of laparoscopic combined with duodenoscope or with choledochoscope surgery in the treatment of gallstones and choledocholithiasis in the elderly

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Clinical analysis of the efficacy and safety of laparoscopic combined with duodenoscope or with choledochoscope surgery in the treatment of gallstones and choledocholithiasis in the elderly