中国普外基础与临床杂志

中国普外基础与临床杂志

大于 70 岁胆总管结石患者腹腔镜胆总管探查术后一期缝合的疗效观察

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目的 探讨腹腔镜胆总管探查术(LCBDE)后一期缝合治疗年龄>70 岁胆总管结石患者的临床疗效。 方法 回顾性分析 2013 年 1 月至 2016 年 12 月期间四川大学华西医院因胆总管结石接受 LCBDE 治疗的 62 例年龄>70 岁患者的临床资料,其中有 30 例 LCBDE 后行 T 管引流(T 管引流组),有 32 例 LCBDE 后行一期胆总管缝合(一期缝合组),比较 2 组患者的术中及术后情况。 结果 2 组患者的性别、年龄、体质量指数、术前合并症、术前 ASA 分级、最大结石直径、结石数量及胆总管直径比较差异均无统计学意义(P>0.05)。2 组患者的手术时间、住院费用、术后总并发症及再入院率比较差异均无统计学意义(P>0.05);与 T 管引流组比较,一期缝合组术中出血量更少(P<0.05)、术后住院时间更短(P<0.05)。 结论 对于年龄>70 岁的胆总管结石患者,在严格掌握适应证、确保术中手术操作熟练的情况下,LCBDE 后行一期胆总管缝合安全、可行,更有利于患者术后的恢复。

Objective To explore clinical effect of primary suture following laparoscopic common bile duct exploration (LCBDE) in treatment of patients aged over 70 years old with common bile duct (CBD) stones. Methods The clinical data of 62 patients aged over 70 years old with CBD stones underwent the LCBDE from January 2013 to December 2016 were retrospectively analyzed. Among them, 30 patients underwent the T tube drainage (T tube drainage group) and 32 patients underwent the primary suture (primary suture group) following the LCBDE. The intraoperative and postoperative statuses of these two groups were compared. Results There were no significant differences in the gender, age, body mass index, preoperative comorbidities and ASA classification, number and maximum diameter of CBD stone, and diameter of CBD between the two groups (P>0.05). There were no significant differences in the operative time, hospitalization cost, rates of total postoperative complications and readmission between the two groups (P>0.05). Compared with the T tube drainage group, the amount of intraoperative bleeding was less (P<0.05) and the postoperative hospital stay was shorter (P<0.05) in the primary suture group. Conclusion Primary suture is safe and feasible following LCBDE for patients aged over 70 years old with CBD stones in case of strict indications and proficiency intraoperation and it is more beneficial to recovery of patient.

关键词: 高龄患者; 腹腔镜胆总管探查术; 一期缝合; T管引流

Key words: elderly patient; laparoscopic common bile duct exploration; primary suture; T tube drainage

引用本文: 蒋松霖, 叶辉. 大于 70 岁胆总管结石患者腹腔镜胆总管探查术后一期缝合的疗效观察. 中国普外基础与临床杂志, 2018, 25(10): 1213-1217. doi: 10.7507/1007-9424.201805009 复制

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