老年患者肝外胆管结石外科治疗的临床研究

目的：探讨采用腹腔镜联合十二指肠镜治疗老年患者肝外胆管结石外科治疗的临床效果。方法：选取本院2011年3月-2013年1月收治的84例肝外胆管结石的老年患者作为研究对象，随机分为试验组和对照组各42例。试验组采用腹腔镜联合十二指肠镜进行治疗，对照组采用腹腔镜下胆囊切除、胆总管探查取石以及T管引流术进行治疗，观察两组患者的术后治疗效果。结果：试验组42例患者成功碎石、取石者38例，成功率90.48%，术后发生高淀粉酶血症1例，胰腺炎1例，穿刺孔出血1例，1例患者出现十二指肠乳头出血。对照组42例患者成功碎石、取石者31例，成功率73.81%，术后发高淀粉酶血症4例，胰腺炎2例，穿刺孔出血2例，3例患者出现十二指肠乳头出血。从患者术后治疗效果和并发症来看，试验组明显优于对照组，两组比较差异有统计学意义（P〈0.05）。结论：应用腹腔镜联合十二指肠镜联合治疗老年肝外胆管结石优于单纯腹腔镜下胆总管探查＋T管引流术，是目前较为安全和有效的方法，复发率低，临床应用价值高。

The Clinical Research of Surgery in Elderly Patients with Extrahepatic Bile Duct Calculi

Objective： To investigate the clinical effect of extrahepatic bile duct surgery of elderly patients in treatment of laparoscopic combined with duodenoscopy.Method：Eighty-four elderly patients with extrahepatic bile duct stones were selected in the hospital from March 2011 to January 2013 as research subjects. All patients were randomly divided into the experimental group and the control group, each group of 42 cases. The experimental group patients were treated by laparoscopic combined with duodenoscopy therapy and the control group patients were treated by laparoscopic cholecystectomy times, common bile duct exploration and T tube drainage. Then clinical effects were compared after treatment.Result：The experimental group patients were successfully gravel, 38 cases were clean stone, the success rate was 90.48%.One case had hyperamylasemia, 1 case had pancreatitis, 1 case had bleeding puncture holes, 1 case had duodenal nipple bleeding. The control group patients were successfully gravel, 31 cases were clean stone, the success rate was 73.81%. Four cases had hyperamylasemia, 2 cases had pancreatitis, 2 cases had bleeding puncture holes, 3 cases had duodenal bleeding. Conclusion： Duodenoscopy combined with laparoscopic is better than laparoscopic common bile duct exploration ＋ T tube drainage in treatment of senile extrahepatic bile duct stones what is a relatively safe and effective method with high value of clinical application.