腹腔镜与十二指肠镜联合治疗老年肝外胆管结石的临床应用.pdf

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1、河北联合大学学报(医学版)2013年9月第15卷第5期JournalofHeibeiUnitedUniversity(HealthSciences)2013Sept，15(5)·621·腹腔镜与十二指肠镜联合治疗老年肝外胆管结石的临床应用代俭华张轩(安徽省芜湖市第二人民医院肝胆外科安徽芜湖241000)[摘要]①目的探讨腹腔镜与十二指肠镜联合治疗老年肝外胆管结石患者的临床应用价值。②方法选择罹患胆囊结石合并胆总管结石的老年患者56例，其中28例前瞻性地应用十二指肠镜下逆行胰胆管造影(ERCP)及十二指肠乳头切开术(EST)与腹腔镜胆囊

2、切除术(IJC)联合治疗，另28例作为对照组，行传统胆囊切除术及胆总管切开加T管引流术。比较两组胆总管内径、胆总管结石最大径、胆总管结石数目、手术总时间、术后胃肠道功能恢复时问、术后并发症的发生率、总住院天数、住院总费用。③结果两组患者在胆总管内径、胆总管结石最大径和胆总管结石数目方面无明显差异；ERCP+EST+LC组较传统手术组手术时间明显缩短(P<0．05)，术后胃肠道功能恢复明显加快(P<0．011)，术后并发症明显少(P<0．O1)，住院天数明显缩短(P<0．01)，住院费用有明显增加(P<0．01)。④结论十二指肠镜和腹腔

3、镜联合治疗胆囊结石合并胆总管结石具有疗效好、痛苦少、创伤小、恢复快、住院时间短等优点，有利于老年患者耐受手术。[关键词]胆总管结石胆囊结石腹腔镜胆囊除术十二指肠镜下逆行胰胆管造影十三指肠乳头切开术[中图分类号]R657．4[文献标识码]A[文章编号]2095—2694(2013)05—621-03Studyofduoden~endoscopycombinedwithlaparoscopyintreatmentofextrahepaticbileductstoneandcholecystolithiasisinoldpatientsDA

4、IJianhua，ZHANGXuan(DepartmentofHepatobiliarySurgery，theSecondPeople&日of“City，Anhuiu241000，China)[ABSTRACT]ObjeetiveToevaluateduodenalendoscopycombinedwithlaparoscopytreatmentforeholedocholithiasisandcho-lelithiasisinoldpatients．Methods56oldpatientssufferedfromcholedocho

5、lithiasisandcholelithiasisweredividedintotwogroups．28patientsinERCP+EST+LCgroupweretreatedwithendoscopicretrogradeeholangiopancreatography(ERCP)，endoscopicsphincterotomy(EST)andlaparoscopiccholecystectomy(LC)，while28patientsincontrolgroupweretreatedwithopencholecys-tect

6、omyandcholedochotomywithTtubedrainage．Commonbileductdiameter，stonesize，stonenumberjncommonbileduct，op—erationtime，gastrointestinalfunctionrecoverytime，complicationrate，hospitalizationtimeandcostwereobservedandanalyzed．ResultsThereWaSnostatisticaldifierenceincommonbiledu

7、ctdiameterandstonesizeandnumbers．Comparedwithcontrolgroup，operationtime，gastrointestinalfunctionrecoverytime，complicationrateandhospitalizationtimeweredecreased(P<0．05，P<0．01)whilethehospitalizationcostwereincreased(P<0．O1)．ConclusionThecombinedapplicationofERCPl／ESTand

8、LCisef-fectiveandfeasibleinthetreatmentofcholangitiswitheholedocholithiasisandcholelithiasisinoldpatients．Itha