老年结石性急性胆管炎患者腹腔镜手术的选择及并发症的预防

发布时间：2018-08-16 18:16

【摘要】：目的探讨腹腔镜胆总管探查取石术(LCBDE)及胆囊切除(LC)治疗老年急性胆管炎合并胆总管结石(CBDS)患者相关并发症的预防。方法将近年收治的部分老年CBDS患者72例根据有无非重度急性胆管炎分为胆管炎组(37例)及非胆管炎组(35例),并比较两组特点。结合围术期综合治疗。四孔法完成经胆总管切开的LCBDE、T管引流及LC。结果两组胆总管直径、结石数目、手术时间及住院天数相当;无中转开腹、胆道损伤、手术死亡及伤口感染。术后胆管炎、胆漏组4例,非胆管炎组3例,均经保守治疗治愈。术后胆管炎组、胆道残余结石4例,非胆管炎组2例,经T管窦道胆道镜取净结石,两组比较差异无统计学意义(P0.05)。胆管炎组术后胆管炎症状及体征明显缓解。结论 LCBDE及T管引流术治疗非重度急性胆管炎安全、有效;把握好胆管炎LCBDE的指征、有效的围术期综合治疗、熟练的腹腔镜及胆道镜技术有助于并发症的预防及减少。
[Abstract]:Objective to investigate the prevention of complications in elderly patients with acute cholangitis complicated with choledocholithiasis by laparoscopic choledocholithotomy (LCBDE) and cholecystectomy (LC). Methods Seventy-two elderly patients with CBDS were divided into two groups: cholangitis group (n = 37) and non-cholangitis group (n = 35) according to the presence or absence of severe acute cholangitis, and the characteristics of the two groups were compared. Combined with perioperative comprehensive treatment. The drainage of LCBDET tube and the drainage of LCby choledocholithotomy were completed by four holes method. Results the diameter of common bile duct, the number of stones, the time of operation and the days of hospitalization were the same between the two groups, and there was no conversion to laparotomy, bile duct injury, operative death and wound infection. Postoperative cholangitis, bile leakage group (4 cases) and non cholangitis group (3 cases) were cured by conservative treatment. Postoperative cholangitis group, 4 cases of residual cholelithiasis, 2 cases of non-cholangitis group, through T-tube sinus choledochoscopy, the two groups were not statistically significant difference (P0.05). In the cholangitis group, the symptoms and signs of cholangitis were relieved. Conclusion LCBDE and T-tube drainage are safe and effective in the treatment of non-severe acute cholangitis, and grasping the indication of LCBDE, effective perioperative comprehensive treatment and skilled laparoscopy and choledochoscopy are helpful for the prevention and reduction of complications.
【作者单位】：首都医科大学附属北京世纪坛医院北京大学第九临床医学院;
【基金】：北京市医院管理局扬帆重点课题资助(No.ZYLX20512) 北京市科委课题资助(No.Z131100004013037)
【分类号】：R657.45

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