目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合胆总管探查(laparoscopic common bile ductexploration,LCBDE)在老年患者中的安全性及有效性。方法对2009年1月～2012年1月140例胆囊结石合并胆总管结石行LC联合LCBDE...目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合胆总管探查(laparoscopic common bile ductexploration,LCBDE)在老年患者中的安全性及有效性。方法对2009年1月～2012年1月140例胆囊结石合并胆总管结石行LC联合LCBDE的临床资料进行回顾性分析,按年龄分为老年组(年龄≥65岁,n=42)和对照组(年龄<65岁,n=98),比较2组手术时间、中转开腹率、术后并发症、术后住院时间、住院费用、术后死亡率有无差异。结果老年组住院费用(17 149.7±8275.8)元,显著高于对照组(13 710.8±5228.4)元(t=2.964,P=0.004);老年组手术时间(100.2±25.8)min与对照组(106.3±48.3)min无统计学差异(t=-0.772,P=0.442);老年组中转开腹率7.1%(3/42)与对照组7.1%(7/98)无统计学差异(χ2=0.000,P=1.000);老年组术后住院时间(13.0±4.5)d与对照组(11.9±4.1)d无统计学差异(t=1.412,P=0.160);老年组术后并发症发生率16.7%(7/42)与对照组15.3%(15/98)无统计学差异(χ2=0.041,P=0.839)。2组均无死亡病例。140例随访8～42个月,平均25.9月:老年组2例结石残留,其中1例术后3个月行体外冲击波碎石后胆道镜经T管窦道取出结石,1例术后2个月行ERCP+EST取石;对照组无结石残留,1例术后20个月胆道结石复发,行ERCP+EST取石。结论 LC联合胆总管探查不仅对年轻患者,对老年患者也是安全有效的。展开更多
目的比较腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)+腹腔镜胆总管切开探查术(laparoscopic common bile duct exploration,LCBDE)治疗老年与非老年胆囊结石合并胆总管结石患者的临床疗效。方法回顾性分析2010年9月至2015年11...目的比较腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)+腹腔镜胆总管切开探查术(laparoscopic common bile duct exploration,LCBDE)治疗老年与非老年胆囊结石合并胆总管结石患者的临床疗效。方法回顾性分析2010年9月至2015年11月期间四川大学华西医院收治的185例行LC+LCBDE治疗的胆囊结石合并胆总管结石患者的临床资料,根据年龄分为老年组74例(年龄≥65岁)和非老年组111例(年龄<65岁),比较2组患者的手术时间、术中出血量、术后肛门排气时间、术后下床活动时间、腹腔引流管留置时间、术后住院时间、总住院时间、住院费用、术后各并发症、计划外镇痛、取石是否成功、中转开腹、结石复发及死亡情况。结果 1术中和术后指标方面。2组患者的手术时间及术中出血量比较差异均无统计学意义(P>0.050),但老年组患者的术后肛门排气时间、术后下床活动时间、腹腔引流管留置时间、术后住院时间、总住院时间及住院费用均长(高)于非老年组,且老年组的留置T管比例高于非老年组(P<0.050)。2术后并发症和计划外镇痛方面。2组患者的胆汁漏、腹膜炎、术后出血、呕吐、胸痛、术后发热(>38.5℃)发生率,以及Clavien-Dindo分级比较差异均无统计学意义(P>0.050),但老年组的计划外镇痛比例较非老年组高(P=0.007)。3手术疗效方面。2组患者的取石成功率、中转开腹率及结石复发率比较差异均无统计学意义(P>0.050)。结论 LC+LCBDE治疗老年胆囊结石合并胆管结石同样安全、有效,值得积极推广和广泛应用。展开更多
目的探讨经内镜逆行胰胆管造影(ERCP)联合熊去氧胆酸(UDCA)与其他两种主流疗法治疗75岁以上老年胆总管结石合并胆囊结石的疗效及术后生存质量的影响因素。方法选取2017年6月至2019年6月山东第一医科大学附属省立医院收治的184例年龄≥7...目的探讨经内镜逆行胰胆管造影(ERCP)联合熊去氧胆酸(UDCA)与其他两种主流疗法治疗75岁以上老年胆总管结石合并胆囊结石的疗效及术后生存质量的影响因素。方法选取2017年6月至2019年6月山东第一医科大学附属省立医院收治的184例年龄≥75岁胆总管结石合并胆囊结石患者,根据治疗方案不同分为ERCP+UDCA组(66例)、腹腔镜胆囊切除术(LC)+腹腔镜胆总管探查术(LCBDE)组(64例)和ERCP+LC组(54例)。统计三组患者一般资料,比较手术疗效、术后近期及远期并发症情况,选择胃肠疾病生存质量指数(GIQLI)量表评定患者术后2年生存质量。计量资料组间比较采用单因素方差分析或Kruskal-Wallis H检验,计数资料组间比较采用χ^(2)检验或Fisher确切概率法。数据两两多重比较均采用Bonferroni校正法。采用多项式Logistic回归模型分析术后2年GIQLI评分的独立影响因素。结果3组患者的年龄、性别、结石数量、合并基础疾病等基线水平具有可比性(P>0.05)。ERCP+UDCA组、LC+LCBDE组和ERCP+LC组在手术时间[43.0(37.0,61.8)min vs 200.0(170.0,243.8)min vs 189.0(172.0,215.5)min]、住院费用[3.19(2.71,3.80)万元vs 4.58(3.81,5.25)万元vs 5.44(4.86,6.52)万元]、住院时间[6.0(5.0,8.8)d vs 10.5(8.0,12.0)dvs 13.0(9.0,15.5)d]、引流管拔除时间[3(2,4)d vs 30(28,30)dvs 4(4,7)d]方面差异均有统计学意义(P均<0.001),其中ERCP+UDCA组的手术时间、住院费用、住院时间和引流管拔除时间较其余两组减少,差异有统计学意义(P均<0.05);3组的手术成功率和术后引流管放置率无统计学差异(P均>0.05)。3组患者的术后近、远期并发症发生率及GIQLI评分组间差异无统计学意义(P均>0.05)。患者年龄增高与术后发生并发症是影响术后2年GIQLI评分的独立危险因素。结论ERCP+UDCA疗法能在不降低老年患者生存质量的前提下使疾病得到有效控制。临床治疗中应避免盲目实行LC,要根据疾病特点�展开更多
BACKGROUND: The recurrence rates of choledocholithiasis depend on the type of the disease. This study was undertaken to examine recurrent lithiasis after surgical treatment of elderly patients with choledocholithiasis...BACKGROUND: The recurrence rates of choledocholithiasis depend on the type of the disease. This study was undertaken to examine recurrent lithiasis after surgical treatment of elderly patients with choledocholithiasis, especially with primary common bile duct stones, and thereby to determine the best treatment modality for choledocholithiasis in the elderly. METHODS: The recurrence rates of choledocholithiasis were calculated from the records of 193 outpatients who had been treated from January 1993 to January 2005 and monitored for periods ranging from I to 12 years (mean 6.7 years). The patients were divided into 3 groups: 81 who had undergone choledocholithotomy and T-tube drainage, 41 who had had choledochoduodenostomy. and 71 patients who had received choledochojejunostomy. RESULTS: Since the 41 choledochoduodenostomy cases had only one recurrence of choledocholithiasis, the recurrence rate was analyzed for the remaining 152 cases, which were divided into two groups: group A with recurrent lithiasis (13 cases), and group B without recurrence (139 cases). The recurrence was found in 7 patients after choledocholithotomy and T-tube drainage (7/81, 8.6%), and in 6 patients after choledochojejunostomy (6/71, 8.5%). The recurrence rates for these procedures were higher than for choledochoduodenostomy (1/41, 2.4%, P<0.05). Moreover, stones recurred in 4 of the 11 patients with primary bile duct stones who underwent choledocholithotomy an T-tube drainage (4/11, 36.4%), and in 5 of the 34 patients who had choledochojejunostomy (5/34, 14.7%). The recurrence rates for these procedures were higher than for choledochoduodenostomy (1/39, 2.6%, P<0.05). The diameter of the common bile duct was more dilated in group A (14.6 +/- 3.9 mm) than in group B (10.8 +/- 4.5 turn, P<0.05). Primary bile duct stones were found in 9 cases of group A (69.2%), and in 36 cases of group B (25.9%, P<0.01). CONCLUSION: Choledochoduodenostomy should be recommended for elderly patients with primary bile duct stones to prevent postoperative recu展开更多
AIM: To investigate whether endoscopic papillary large balloon dilation(EPLBD) can be safety and effectively performed in patients aged ≥ 80 years. METHODS: Lithotomy by EPLBD was conducted in 106 patients with bile ...AIM: To investigate whether endoscopic papillary large balloon dilation(EPLBD) can be safety and effectively performed in patients aged ≥ 80 years. METHODS: Lithotomy by EPLBD was conducted in 106 patients with bile duct stones ≥ 13 mm in size or with three or more bile duct stones ≥ 10 mm. The patients were divided into group A(< 80 years) and group B(≥ 80 years). Procedure success rate, number of endoscopic retrograde cholangiopancreatographies(ERCP), and incidence of complications were examined in both groups.RESULTS: Group B tended to include significantly more patients with peripapillary diverticulum, hypertension, hyperlipemia, cerebrovascular disease/dementia, respiratory disease/cardiac disease, and patients administered an anticoagulant or antiplatelet agent(P < 0.05). The success rate of the initial lithotomy was 88.7(94/106)%. The final lithotomy rate was 100(106/106)%. Complications due to treatment procedure occurred in 4.72(5/106)% of the patients. There was no significant difference in procedure success rate, number of ERCP, or incidence of complications between group A and group B.CONCLUSION: EPLBD can be safely performed in elderly patients, the same as in younger patients.展开更多
文摘目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合胆总管探查(laparoscopic common bile ductexploration,LCBDE)在老年患者中的安全性及有效性。方法对2009年1月～2012年1月140例胆囊结石合并胆总管结石行LC联合LCBDE的临床资料进行回顾性分析,按年龄分为老年组(年龄≥65岁,n=42)和对照组(年龄<65岁,n=98),比较2组手术时间、中转开腹率、术后并发症、术后住院时间、住院费用、术后死亡率有无差异。结果老年组住院费用(17 149.7±8275.8)元,显著高于对照组(13 710.8±5228.4)元(t=2.964,P=0.004);老年组手术时间(100.2±25.8)min与对照组(106.3±48.3)min无统计学差异(t=-0.772,P=0.442);老年组中转开腹率7.1%(3/42)与对照组7.1%(7/98)无统计学差异(χ2=0.000,P=1.000);老年组术后住院时间(13.0±4.5)d与对照组(11.9±4.1)d无统计学差异(t=1.412,P=0.160);老年组术后并发症发生率16.7%(7/42)与对照组15.3%(15/98)无统计学差异(χ2=0.041,P=0.839)。2组均无死亡病例。140例随访8～42个月,平均25.9月:老年组2例结石残留,其中1例术后3个月行体外冲击波碎石后胆道镜经T管窦道取出结石,1例术后2个月行ERCP+EST取石;对照组无结石残留,1例术后20个月胆道结石复发,行ERCP+EST取石。结论 LC联合胆总管探查不仅对年轻患者,对老年患者也是安全有效的。
文摘目的比较腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)+腹腔镜胆总管切开探查术(laparoscopic common bile duct exploration,LCBDE)治疗老年与非老年胆囊结石合并胆总管结石患者的临床疗效。方法回顾性分析2010年9月至2015年11月期间四川大学华西医院收治的185例行LC+LCBDE治疗的胆囊结石合并胆总管结石患者的临床资料,根据年龄分为老年组74例(年龄≥65岁)和非老年组111例(年龄<65岁),比较2组患者的手术时间、术中出血量、术后肛门排气时间、术后下床活动时间、腹腔引流管留置时间、术后住院时间、总住院时间、住院费用、术后各并发症、计划外镇痛、取石是否成功、中转开腹、结石复发及死亡情况。结果 1术中和术后指标方面。2组患者的手术时间及术中出血量比较差异均无统计学意义(P>0.050),但老年组患者的术后肛门排气时间、术后下床活动时间、腹腔引流管留置时间、术后住院时间、总住院时间及住院费用均长(高)于非老年组,且老年组的留置T管比例高于非老年组(P<0.050)。2术后并发症和计划外镇痛方面。2组患者的胆汁漏、腹膜炎、术后出血、呕吐、胸痛、术后发热(>38.5℃)发生率,以及Clavien-Dindo分级比较差异均无统计学意义(P>0.050),但老年组的计划外镇痛比例较非老年组高(P=0.007)。3手术疗效方面。2组患者的取石成功率、中转开腹率及结石复发率比较差异均无统计学意义(P>0.050)。结论 LC+LCBDE治疗老年胆囊结石合并胆管结石同样安全、有效,值得积极推广和广泛应用。
文摘目的探讨经内镜逆行胰胆管造影(ERCP)联合熊去氧胆酸(UDCA)与其他两种主流疗法治疗75岁以上老年胆总管结石合并胆囊结石的疗效及术后生存质量的影响因素。方法选取2017年6月至2019年6月山东第一医科大学附属省立医院收治的184例年龄≥75岁胆总管结石合并胆囊结石患者,根据治疗方案不同分为ERCP+UDCA组(66例)、腹腔镜胆囊切除术(LC)+腹腔镜胆总管探查术(LCBDE)组(64例)和ERCP+LC组(54例)。统计三组患者一般资料,比较手术疗效、术后近期及远期并发症情况,选择胃肠疾病生存质量指数(GIQLI)量表评定患者术后2年生存质量。计量资料组间比较采用单因素方差分析或Kruskal-Wallis H检验,计数资料组间比较采用χ^(2)检验或Fisher确切概率法。数据两两多重比较均采用Bonferroni校正法。采用多项式Logistic回归模型分析术后2年GIQLI评分的独立影响因素。结果3组患者的年龄、性别、结石数量、合并基础疾病等基线水平具有可比性(P>0.05)。ERCP+UDCA组、LC+LCBDE组和ERCP+LC组在手术时间[43.0(37.0,61.8)min vs 200.0(170.0,243.8)min vs 189.0(172.0,215.5)min]、住院费用[3.19(2.71,3.80)万元vs 4.58(3.81,5.25)万元vs 5.44(4.86,6.52)万元]、住院时间[6.0(5.0,8.8)d vs 10.5(8.0,12.0)dvs 13.0(9.0,15.5)d]、引流管拔除时间[3(2,4)d vs 30(28,30)dvs 4(4,7)d]方面差异均有统计学意义(P均<0.001),其中ERCP+UDCA组的手术时间、住院费用、住院时间和引流管拔除时间较其余两组减少,差异有统计学意义(P均<0.05);3组的手术成功率和术后引流管放置率无统计学差异(P均>0.05)。3组患者的术后近、远期并发症发生率及GIQLI评分组间差异无统计学意义(P均>0.05)。患者年龄增高与术后发生并发症是影响术后2年GIQLI评分的独立危险因素。结论ERCP+UDCA疗法能在不降低老年患者生存质量的前提下使疾病得到有效控制。临床治疗中应避免盲目实行LC,要根据疾病特点�
文摘BACKGROUND: The recurrence rates of choledocholithiasis depend on the type of the disease. This study was undertaken to examine recurrent lithiasis after surgical treatment of elderly patients with choledocholithiasis, especially with primary common bile duct stones, and thereby to determine the best treatment modality for choledocholithiasis in the elderly. METHODS: The recurrence rates of choledocholithiasis were calculated from the records of 193 outpatients who had been treated from January 1993 to January 2005 and monitored for periods ranging from I to 12 years (mean 6.7 years). The patients were divided into 3 groups: 81 who had undergone choledocholithotomy and T-tube drainage, 41 who had had choledochoduodenostomy. and 71 patients who had received choledochojejunostomy. RESULTS: Since the 41 choledochoduodenostomy cases had only one recurrence of choledocholithiasis, the recurrence rate was analyzed for the remaining 152 cases, which were divided into two groups: group A with recurrent lithiasis (13 cases), and group B without recurrence (139 cases). The recurrence was found in 7 patients after choledocholithotomy and T-tube drainage (7/81, 8.6%), and in 6 patients after choledochojejunostomy (6/71, 8.5%). The recurrence rates for these procedures were higher than for choledochoduodenostomy (1/41, 2.4%, P<0.05). Moreover, stones recurred in 4 of the 11 patients with primary bile duct stones who underwent choledocholithotomy an T-tube drainage (4/11, 36.4%), and in 5 of the 34 patients who had choledochojejunostomy (5/34, 14.7%). The recurrence rates for these procedures were higher than for choledochoduodenostomy (1/39, 2.6%, P<0.05). The diameter of the common bile duct was more dilated in group A (14.6 +/- 3.9 mm) than in group B (10.8 +/- 4.5 turn, P<0.05). Primary bile duct stones were found in 9 cases of group A (69.2%), and in 36 cases of group B (25.9%, P<0.01). CONCLUSION: Choledochoduodenostomy should be recommended for elderly patients with primary bile duct stones to prevent postoperative recu
文摘AIM: To investigate whether endoscopic papillary large balloon dilation(EPLBD) can be safety and effectively performed in patients aged ≥ 80 years. METHODS: Lithotomy by EPLBD was conducted in 106 patients with bile duct stones ≥ 13 mm in size or with three or more bile duct stones ≥ 10 mm. The patients were divided into group A(< 80 years) and group B(≥ 80 years). Procedure success rate, number of endoscopic retrograde cholangiopancreatographies(ERCP), and incidence of complications were examined in both groups.RESULTS: Group B tended to include significantly more patients with peripapillary diverticulum, hypertension, hyperlipemia, cerebrovascular disease/dementia, respiratory disease/cardiac disease, and patients administered an anticoagulant or antiplatelet agent(P < 0.05). The success rate of the initial lithotomy was 88.7(94/106)%. The final lithotomy rate was 100(106/106)%. Complications due to treatment procedure occurred in 4.72(5/106)% of the patients. There was no significant difference in procedure success rate, number of ERCP, or incidence of complications between group A and group B.CONCLUSION: EPLBD can be safely performed in elderly patients, the same as in younger patients.
