标题：腹腔镜结合胆道镜探查取石术治疗老年胆囊结石合并胆总管结石疗效评价

      作者：刘健 1，郭嘉 1，宋仲学 1，李袆龙 2    1.渭南市第二医院外科，陕西 渭南 714000；2.西安市第九医院普外科，陕西 西安 710054

      卷次： 2019年30卷16期

      【摘要】 目的 探讨腹腔镜结合胆道镜探查取石术治疗老年胆囊结石合并胆总管结石的临床疗效，为患者临床诊疗提供依据。方法 选择2017年1月至2018年12月在渭南市第二医院进行诊治的胆囊结石合并胆总管结石老年患者102例为研究对象，按照随机数表法将患者分为对照组和观察组，每组51例。对照组患者采用传统开腹手术治疗，观察组采用腹腔镜结合胆道镜探查取石术治疗。比较两组患者的住院时间、手术时间、术中出血量、临床疗效、丙氨酸氨基转移酶(ALT)、血清总胆红素(TBIL)以及并发症发生情况。结果 观察组患者的治疗总有效率为98.04%，明显高于对照组的82.35%，差异有统计学意义(P<0.05)；观察组患者的手术时间为(136.46±37.51) min，明显长于对照组的(98.57±24.06) min，术中出血量及住院时间分别为(48.52±10.59) mL，(4.47±1.43) d，均明显少于对照组的(124.48±29.82) mL、(12.73±3.06) d，差异均有统计学意义(P<0.05)；治疗后，观察组患者的TBIL与ALT水平分别为(8.27±3.72) μmol/L，(15.42±4.03) U/L，明显低于对照组有(13.48±4.31) μmol/L，(21.57±5.28) U/L，差异均有统计学意义(P<0.05)；观察组患者的术后并发症发生率为 15.68%，明显低于对照组的 31.37%，差异有统计学意义(P<0.05)。结论 腹腔镜结合胆道镜探查取石术治疗老年胆囊结石合并胆总管结石能明显缩短住院时间，减少术中出血量，且安全性较高，疗效显著。
      【关键词】 胆囊结石；胆总管结石；老年；探查取石术；腹腔镜；胆道镜；安全性；疗效
      【中图分类号】 R657.4+2 【文献标识码】 A 【文章编号】 1003—6350（2019）16—2082—03

Clinical efficacy of laparoscopic-choledochoscopic cholelithotomy for the treatment of cholecystolithiasiscomplicated with choledocholithiasis in the elderly.
LIU Jian 1, GUO Jia 1, SONG Zhong-xue 1, LI Hui-long 2. 1.Department of Surgery, the Second Hospital of Weinan City, Weinan 714000, Shaanxi, CHINA; 2. Department of GeneralSurgery, the Ninth Hospital of Xi'an City, Xi'an 710054, Shaanxi, CHINA
【Abstract】 Objective To investigate the clinical efficacy of laparoscopic-choledochoscopic cholelithotomy forthe treatment of cholecystolithiasis with choledocholithiasis in the elderly, and to provide evidence for the diagnosis andtreatment of the disease. Methods A total of 102 elderly patients with cholecystolithiasis complicating choledocholithi-asis who were treated in the Second Hospital of Weinan City from January 2017 to December 2018 were selected as sub-jects, which were randomly divided into the control group (n=51) and the observation group (n=51) according to the ran-dom number table. The patients in the control group were treated with conventional open surgery, while those in the ob-servation group were treated with laparoscopic-choledochoscopic cholelithotomy. The hospitalization time, operationtime, intraoperative blood loss, clinical efficacy, alanine aminotransferase (ALT), serum total bilirubin (TBIL), and com-plications were compared between the two groups. Results The total effective rate of the observation group was98.04%, which was significantly higher than 82.35% of the control group (P<0.05). The operation time of the observa-tion group was (136.46±37.51) min, significantly longer than (98.57±24.06) min of the control group, but the intraopera-tive blood loss and hospitalization time were (48.52±10.59) mL, (4.47±1.43) d, significantly less or shorter than (124.48±29.82) mL, (12.73±3.06) d in the control group (P<0.05). After treatment, the TBIL and ALT levels in the observationgroup were (8.27±3.72) μmol/L and (15.42±4.03) U/L, significantly lower than (13.48±4.31) μmol/L and (21.57±5.28) U/Lin the control group (P<0.05). The incidence of complications in the observation group was 15.68%, which was signifi-cantly lower than 31.37% in the control group (P<0.05). Conclusion Laparoscopic-choledochoscopic cholelithotomyfor the treatment of cholecystolithiasis complicated with choledocholithiasis in the elderly can significantly shorten thelength of hospital stay, reduce the amount of intraoperative blood loss, with good safety and significant efficacy, which isworthy of clinical application.
      【Key words】 Cholecystolithiasis; Choledocholithiasis; The elderly; Cholelithotomy; Laparoscopy; Choledochos-copy; Safety; Efficacy