手术路径对腹腔镜联合胆道镜治疗老年肝外胆道系统结石效果的影响

　　[摘要] 目的 觀察手术路径对腹腔镜联合胆道镜治疗老年肝外胆道系统结石临床效果的影响。 方法 回顾性分析2013年4月～2015年7月150例肝外胆道系统结石老年患者的临床资料，根据术式分为A、B、C三组，每组50例，A、B、C三组分别采用改良三孔法、传统四孔法、改良五孔法建立腹腔镜手术路径。观察三组手术时间、术中出血量、胆管缝合时间、排气时间、术后自主活动时间、引流管留置时间、住院时间和住院总费用及并发症情况。结果 A组成功率为90.0%，B组成功率为92.0%，C组成功率为92.0%，中转开腹者13例。C组手术时间、术中出血量和胆管缝合时间均少于A、B组，差异有统计学意义（P均<0.05），A、B组相比，差异无统计学意义（P>0.05）。排气时间、术后自主活动时间、引流管留置时间、住院时间和住院总费用三组两两比较，差异无统计学意义（P>0.05）。术后并发症三组间两两比较，差异无统计学意义（P>0.05）。 结论 三种方式建立腹腔镜手术路径，对老年的肝外胆道系统结石均有明显的治疗效果，其中，改良五孔法手术时间、术中出血量和胆管缝合时间较前两组短、少，此种手术方式在临床上更加安全、理想。
　　[关键词] 肝外胆道系统结石；腹腔镜；胆道镜；老年患者
　　[中图分类号] R657.4+2 [文献标识码] B [文章编号] 1673-9701（2018）08-0049-04
　　Influence of surgical path on the effectiveness of treatment combining laparoscope and choledochoscope in elder patients with extrahepatic biliary tract calculi
　　YUAN Bo LI Jianchao HUANG Hai LIU Yong
　　Department of General Surgery，Changzhou TCM Hospital in Jiangsu Province，Changzhou 213000，China
　　[Abstract] Objective To investigate the influence of surgical path on the clinical effectiveness of treatment combing laparoscope and choledochoscope in elder patients with extrahepatic biliary tract calculi. Methods Clinical records of 150 elder patients with extrahepatic biliary tract calculi in our hospital from April 2013 to July 2015 were analyzed retrospectively. They were divided into A， B and C these three groups according to their surgical treatment， with 50 cases in each groups. Path of laparoscopic surgery of patients in A， B and C group were established by using modified 3-port， conventional 4-port and modified 5-port method respectively. The duration of operation， blood loss during operation， time of bile duct suture， time of anal exhaust， time of autonomic activity after operation， drainage tube duration， time of hospitalization， total hospitalization expenses and complications were observed. Results Success rates of A， B and C group were 90.0%， 92.0% and 92.0% respectively. 13 cases turned to laparotomy during operation. The duration of operation， blood loss during operation and the time of bile duct suture in C group were less than A and B group， the differences were statistically significant（P<0.05 for all）. There was no significant difference between A group and B group（P>0.05）. The time of anal exhaust， time of autonomic activity after operation， drainage tube duration， time of hospitalization， total hospitalization expenses and complications were not significantly different between each group （P>0.05）. The incidence of complications after operation was not statistically different between each group（P>0.05）. Conclusion Paths of laparoscopic surgery of patients established through three methods were significantly effective for elder patients with extrahepatic biliary tract calculi. The duration of operation， blood loss during operation and time of bile duct suture by using modified 5-port method were shorter and less than the other two methods. This surgical method was safer and more satisfactory in clinic.

相关热词搜索：胆道 结石 路径 老年 腹腔镜