手術(shù)路徑對(duì)腹腔鏡聯(lián)合膽道鏡治療老年肝外膽道系統(tǒng)結(jié)石效果的影響

　　[摘要] 目的 觀察手術(shù)路徑對(duì)腹腔鏡聯(lián)合膽道鏡治療老年肝外膽道系統(tǒng)結(jié)石臨床效果的影響。 方法 回顧性分析2013年4月～2015年7月150例肝外膽道系統(tǒng)結(jié)石老年患者的臨床資料，根據(jù)術(shù)式分為A、B、C三組，每組50例，A、B、C三組分別采用改良三孔法、傳統(tǒng)四孔法、改良五孔法建立腹腔鏡手術(shù)路徑。觀察三組手術(shù)時(shí)間、術(shù)中出血量、膽管縫合時(shí)間、排氣時(shí)間、術(shù)后自主活動(dòng)時(shí)間、引流管留置時(shí)間、住院時(shí)間和住院總費(fèi)用及并發(fā)癥情況。結(jié)果 A組成功率為90.0%，B組成功率為92.0%，C組成功率為92.0%，中轉(zhuǎn)開(kāi)腹者13例。C組手術(shù)時(shí)間、術(shù)中出血量和膽管縫合時(shí)間均少于A、B組，差異有統(tǒng)計(jì)學(xué)意義（P均<0.05），A、B組相比，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。排氣時(shí)間、術(shù)后自主活動(dòng)時(shí)間、引流管留置時(shí)間、住院時(shí)間和住院總費(fèi)用三組兩兩比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。術(shù)后并發(fā)癥三組間兩兩比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。 結(jié)論 三種方式建立腹腔鏡手術(shù)路徑，對(duì)老年的肝外膽道系統(tǒng)結(jié)石均有明顯的治療效果，其中，改良五孔法手術(shù)時(shí)間、術(shù)中出血量和膽管縫合時(shí)間較前兩組短、少，此種手術(shù)方式在臨床上更加安全、理想。
　　[關(guān)鍵詞] 肝外膽道系統(tǒng)結(jié)石；腹腔鏡；膽道鏡；老年患者
　　[中圖分類(lèi)號(hào)] R657.4+2 [文獻(xiàn)標(biāo)識(shí)碼] B [文章編號(hào)] 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.

相關(guān)熱詞搜索：膽道 結(jié)石 路徑 老年 腹腔鏡