双镜联合不同入路治疗老年人肝外胆管结石的比较

Comparative Analysis of Different Route of Laparoscopy with Choledochoscopy and Laparoscopy with Duodenoscopy in the Treatment of Cholelithiasis Complicated by Choledocholithiasis in Elderly Patients

摘要: 目的：研究经内镜乳头括约肌切开术(Endoscopic Sphincterotomy, EST)联合腹腔镜胆囊切除术(Laparoscopic Choiecystectomy, LC)治疗老年人肝外胆管结石的效果。方法：回顾分析我院采用EST联合LC序贯治疗42例(方案A)老年胆囊结石并胆总管结石患者的临床资料并与同期42例腹腔镜联合胆道镜(方案B)方法进行比较。结果：二组取石成功率均100%，没有发生严重并发症。在肛门排气、住院时间方面方案A优于方案B (22.3 ± 5.7 vs 57.7 ± 8.6; 8.75 ± 3.17 vs 13.16 ± 2.38; P < 0.01)。结论：EST联合LC或腹腔镜联合胆道镜在治疗老年人胆囊结石合并胆总管结石，均具有创伤小、恢复快、术后生活质量高等优点，但在携带T管及病情恢复方面，前者更具优势。

Abstract: Objective: To study the efficacy of Endoscopic Sphincterotomy (EST) and Laparoscopic Cholecys-tectomy (LC) in the treatment of elderly patients with cholelithiasis and choledocholithiasis. Me-thod: Retrospective analysis of 42 elderly patients with cholecystolithiasis and choledocholithiasis which were treated by EST and LC (scheme A), and 42 cases were analysed in same period of laparoscopy combined with choledochoscopy (scheme B) in the treatment of cholelithiasis complicated by choledocholithiasis in elderly patients in our hospital. Result: Success rate of the two schemes was 100%. No other serious complications were happened. Scheme A was better than scheme B in the bowel moved recovery and hospitalization (22.3 ± 5.7 vs 57.7 ± 8.6; 8.75 ± 3.17 vs 13.16 ± 2.38; P < 0.01). Conclusion: EST joint LC and laparoscopy combined with choledochoscopy are a minimally invasive operation for elderly patients with cholelithiasis and choledocholithiasis, and it is safe, effective, feasible, but scheme A shows good clinical results than scheme B.