胆囊穿刺造瘘后双通道胆道镜保胆取石与腹腔镜胆囊切除术治疗老年患者结石性胆囊炎疗效的比较

目的比较超声引导双通道胆囊穿刺造瘘联合胆道镜保胆取石与胆囊穿刺造瘘后行腹腔镜胆囊切除术（1aparoscopiccholecystectomy，LC）治疗老年患者急性结石性胆囊炎的临床疗效。方法回顾性分析2012年1～9月接受双通道胆囊穿刺造瘘联合胆道镜保胆取石治疗的30例老年结石性胆囊炎（保胆取石组）和胆囊穿刺造瘘后行Lc治疗的30例老年结石性胆囊炎（Lc组）的临床资料，比较2组手术操作时间、术中出血量、住院时间、消化不良症状发生率等。结果60例均穿刺置管成功，带管时间14d-2个月，平均30d。4～8周后，保胆取石组30例成功行胆道镜取石，结石取净率100％，取石过程中无出血、漏胆、继发胆总管结石、切口感染等手术并发症。LC组28例三孔法完成LC，2例因粘连组织难以分离中转开腹手术，术中、术后均无严重并发症。保胆取石组术中出血量（8．8±1．7）ml，显著少于LC组（18．9±1．2）ml（t=-25．968，P=0．000）；保胆取石组住院时间（4．4±0．6）d，显著短于LC组（5．6±0．5）d（t=-8．243，P=0．000）。保胆取石组术后随访3、6、12个月，B超检查1例复发，5例有上腹部不适、腹泻、食欲不佳等消化不良症状，发生率16．7％（5／30），LC组术后21例有消化不良症状，发生率70．o％（21／30），2组比较有显著性差异（x2=17．376，P=0．000）。结论超声引导双通道胆囊穿刺造瘘联合胆道镜保胆取石操作简便，在术中出血量、住院时间、远期生活质量等方面均优于胆囊造瘘后行LC。

Clinical Comparison Between Double Tract Cholecystostomy Combined with Choledochoscopic Cholecystolithotomy and Laparoscopic Cholecystectomy after Cholecystostomy in Senile Patients

Objective To compare clinical outcomes between double tract cholecystostomy combined with choledochoscopic cholecystolithotomy and laparoscopic cholccystectomy （LC） after cholecystostomy in senile patients with acute calculous cholecystitis. Methods Clinical data of 30 cases of cholecystostomy combined with choledochoscopic cholecystolithotomy （cholecystolithotomy group） and 30 cases of laparoscopie cholecystectomy after cholecystostomy （LC group） from January to September 2012 were collected retrospectively. The therapeutic effects such as operation time, blood loss, hospital stay, and the quality of life were respectively analyzed. Results The puncture of the gallbladder and the cholecystostomy were performed successfully in all the 60 cases. The average drainage time was 30 days （range, 14 d -2 months）. In the cholecystolithotomy group, the gallbladder stones were completely and successfully removed within 4 - 8 weeks after surgery, without complications such as bleeding, biliary leakage, and bile duct injury. In the LC group, the cholecystectomy was successfully performed by using 3-port method in 28 cases, while a conversion to open cholecystectomy was required because of severe adhesion in 2 cases, without intra- or post-operative complications. The intraoperative blood loss was significantly less in the choleeystolithotomy group （ 8.8 ± 1.7 ） ml than that in the LC group （ 18.9 ± 1.2） ml （ t = - 25. 968, P = O. 000 ）. The length of hospital stay was significantly shorter in the cholecystolithotomy group （4.4 ± 0. 6 ） d than that in the LC group （5.6 ±0.5 ） d （t =- 8. 243, P = 0. 000）. Postoperative follow-up for 3, 6, and 12 months, respectively, in the cholecystolithotomy group found 1 case of recurrence under B-ultrasonography and 5 cases of indigestion such as epigastric discomfort, diarrhea, or poor appetite, with a rate of 16.7% （5/30）. Symptoms of indigestion were noted in 21 cases after surgery inthe LC group, with a rate of 70.0% （21/30）. There wa