腹腔镜联合胆道镜微创治疗老年人胆总管结石及胆囊结石的临床研究

目的：研究腹腔镜胆总管探查术（LCBDE）及腹腔镜胆囊切除术（LC）联合胆道镜检查取石术治疗老年人胆总管结石（CBDS）合并胆囊结石的可行性及安全性。方法：2011-01-2014-04,53例CBDS及胆囊结石的老年患者实施LCBDE、LC及胆道镜检查取石术。梗阻性黄疸27例,急性胆管炎13例,急性胆囊炎32例,急性胰腺炎2例,肝脓肿1例。肝硬化3例,肝细胞癌1例,慢性阻塞性肺疾病19例,高血压17例,糖尿病13例。术中放置T管及腹腔引流管,观察并分析术后临床病理数据。结果：51例老年患者成功实施腹腔镜及胆道镜联合手术,2例中转开腹。1例因原发性肝癌同时行腹腔镜肝切除术,另1例行十二指肠瘘修补术。平均手术时间（87.9±20.2）min。平均出血量（47.1±51.8）ml。继发性胆总管结石45例,原发性结石6例。发现意外胆囊癌2例。平均术后住院时间（6.6±2.3）d。术后胆漏2例,肺部感染3例,胆道感染2例。未发生胆总管残余结石。结论：腹腔镜联合胆道镜微创治疗老年人CBDS及胆囊结石安全可行,治疗效果良好。

Minimally invasive treatment of common bile duct and gallbladder stones with laparoscope and choledocho- scope in elderly patients

Objective： To study the feasibility and safety of laparoscopic common bile duct exploration （LCBDE） and laparoscopic cholecystectomy （LC） combined with choledochoscopy for the treatment of elderly patients with common bile duct stones （CBDS） and gallstones. Methods： From January 2011 to April 2014,53 elderly patients with CBDS and gallstones underwent LCBDE, LC and choledochoscopy. There was obstructive jaundice in 27 patients, acute cholangitis in 13, acute cholecystitis in 32, acute pancreatitis in2, hepatic abscess in 1, liver cirrhosis in 3, hepatocellular carcinoma （HCC） in 1, chronic obstructive lung disease in 19 ,hypertensive disease in 17,and type lI diabetes in 13. The T-type tube and abdominal drainage tube were placed for all patients~ The clinicopathologic data were observed and analyzed. Results： The surgical procedure of laparoscope and choledochoscope was Successfully performed for 51 elderly patients and the other 2 patients were converted to open surgery. One patient underwent laparoscopic hepatectomy for.HCC and another received laparoscopic closure of duodenal fistula. The mean operation time was （87. 9 ± 20. 2） minutes, and the mean blood loss was （47. 1 ± 51. 8） ml. There was secondary CBDS in 45 patients and primary CBDS in 6. The unsuspected gallbladder cancer was found in 2 patients after surgery. The mean postoperative hospital stay was （6.6±2.3）days. The postoperative bile leak occurred in 2 patients, pulmonary infection in 3 and infection of biliary tract in 2. There was no postoperative retained CBDS in all patients. Conclusion：The laparoscopic and choledochoscopic treatment is a safe,feasible and effective method for elderly patients with C]3DS and gallstones.