腹腔镜联合纤维胆道镜治疗老年胆总管结石108例临床体会

目的:探讨腹腔镜联合纤维胆道镜治疗老年胆总管结石患者的临床应用价值。方法:回顾分析2005年1月至2013年9月为108例老年胆总管结石患者行腹腔镜联合纤维胆道镜胆囊切除、胆总管切开胆道镜探查取石+T管引流术的临床资料。结果:97例顺利完成手术,11例中转开腹,无死亡病例。手术时间50~150 min,平均(90.0±8.7)min;术后3例发生胆漏,予以保守治疗7~9 d痊愈。术后住院12~15 d,术后第10天夹闭T管,第12天行T管造影,均未见胆管残余结石,6~8周拔除T管。随访1~24个月,平均(6.0±1.2)个月,行肝功能、B超、腹部CT或MRCP复查,无黄疸、胰腺炎、胆管狭窄、结石复发等并发症发生。结论:腹腔镜联合纤维胆道镜行胆囊切除、胆总管切开探查取石+T管引流术治疗老年胆总管结石安全、微创、有效。良好的围手术期处理是老年患者手术成功的重要保障。

The clinical experience of laparoscopy combined with fibrocholedochoscopy in the treatment of choledocholithiasis for 108 aged patients

Objective：To investigate the clinical application value of laparoscopy combined with fibrocholedochoscopy in the treatment of choledocholithiasis in aged patients. Methods：The clinical data of 108 aged patients suffered from choledocholithiasis who underwent laparoscopic cholecystectomy and laparoscopic combined with fibrocholedochoscopic choledocholithotomy T tube drainage from Jan. 2005 to Sep. 2013 were retrospectively analyzed. Results：The operation was successful in 97 cases,and 11 cases were converted to laparotomy,no death occurred. The mean operative time was（90. 0 ± 8. 7） min,with a range from 50 to 150 min. Bile leakage occurred in 3 patients,and was cured 7-9 d after conservative treatment. The patients were discharged from hospital in 12 to 15 d after the operation. T-tube was clamped at the tenth day and T-tube radiography was performed at the twelfth day after the operation,no residual stones of the common bile duct were detected,and the T-tube was removed in 6 to 8 weeks after the operation. The patients were followed up from 1 to 24 months,mean（6. 0 ± 1. 2） months,during which B-ultrasonography,liver function,CT or MRCP were examined.No complications such as jaundice,pancreatitis,biliary stenosis,or recurrent calculi occurred. Conclusions：Laparoscopic cholecystectomy and laparoscopic combined with fibrocholedochoscopic choledocholithotomy T tube drainage is safe,minimally invasive and effective for aged patients with choledocholithiasis. Good perioperative management is the guarantee of the successful operation in aged patients.