LC联合LTCBDE在老年急性胰腺炎合并胆囊结石伴胆总管结石患者中的应用及安全性研究

目的对老年急性胰腺炎合并胆囊结石伴胆总管结石早期行腹腔镜胆囊切除联合腹腔镜胆总管探查术(Laparoscopic Cholecystectomy plus Laparoscopic Transcystic Common Bile Duct Exploration,LC+LCBDE)的病例进行回顾性分析,并评估其安全性。方法选取2012年10月~2016年10月我科收治的急性水肿型胰腺炎合并胆囊结石伴胆总管结石患者443例,分为四组,其中年龄大于60岁,行LC+LTCBDE患者为老年LTCBDE组(n=101),行LC+LTDBDE患者为老年LTDBDE组(n=98);年龄小于60岁,行LC+LTCBDE患者为中青年LTCBDE组(n=132),行LC+LTDBDE患者为中青年LTCBDE组(n=112)。对各组手术中情况、手术并发症、术后恢复情况等方面进行比较。结果与老年LTDBDE组(3.14±0.33h)和中青年LTDBDE组(3.11±0.34h)比较,老年LTCBDE组(2.24±0.23h)和中青年LTCBDE组(2.12±0.40h)手术时间明显缩短(P0.05);术中出血量(△Hb)及中转开腹率差异均无统计学意义(P0.05)。与中青年LTCBDE组(1/132)、中青年LTDBDE组(2/112)比较,老年LTCBDE组(8/155)、老年LTCBDE组(6/98)肺部感染高(P0.05),差异有统计学意义(P0.05)。其余并发症胆漏、胆总管损伤、切口感染、肠梗阻四组间两两比较,均无显著性差异(P0.05)。与中青年LTCBDE组(3.24±0.11 d)与中青年LTDBDE组(3.54±0.20d)比较,老年LTCBDE组(6.72±0.44d)、老年LTDBDE组(7.45±0.20d)住院天数延长,差异有统计学意义(PO.05)。胰腺炎复发率、残余结石发生率差异均无统计学意义(P0.05)。结论老年急性胰腺炎合并胆囊结石伴胆总管结石患者在胰腺炎控制后,即可选择早期施行LC+LTCBDE,并不影响手术安全性。经胆囊管路径探查胆总管优于其他术式,值得推广。

The research on safety of Early implementation of laparoscopic cholecystectomy associated with laparoscopic transcystic common bile duct exploration for elderly patients with acute pancreatitis associated with gallbladder and CBD stone

Objective To evaluate the safety of LC in elderly patients (older than 60 years) with acute pancreatitis associated with CBD and gallbladder stone.Method 443 patients were subjected to LC + LCBDE for acute pancreatitis associated with gallstone and CBD stone between October 2012 to October 2016 in emergency surgery were investigated.patients aged over 60 years old and carried out by LC + LTCBDE as the elderly LTCBDE group (experimental group,n =101),less than 60 years of old and carried out by LC + LTCBDE as young/middle LTCBDE group (control group,n =132),patients aged over 60 years old and carried out by LC + LTDBDE as the elderly LTDBDE group (control group,n =98),less than 60 years of old and carried out by LC + LTCBDE as young/middle LTCBDE group (control group,n =112).The operating time,intraoperative bleeding,the frequency of conversion to open surgery,postoperative complications,postoperative recurrence rate of pancreatitis,postoperative hospital stay were compared.Results Compared to Operating time of elderly LTDBDE group (3.14 ± 0.33h) or young/middle LTDBDE group (3.11 ± 0.34h),there were obviously difference in Operating time of elderly LTCBDE group(2.24 ±0.23h) or young/middle LTCBDE group(2.12 ± 0.40h) (P ＜ 0.05),Compared to those of the young/middle groups (P ＜ 0.05).There exists an prolonged postoperative hospitalization time in elderly LTCBDE group/elderly LTDBDE group (5.34 ± 0.44d,4.24 ± 0.11 d) (P ＜ 0.05).The bile leakage and bile duct injury in either groups and postoperative recurrence rate of pancreatitis had no difference in either groups (P ＞ 0.05).Conclusion extremely elderly patients suffering acute pancreatitis associated with gallstone should be subjected to LC + LTCBDE,which Security has been confirmed.