急诊腹腔镜胆总管探查术在超高龄急性胆管炎患者中的应用效果

摘要

目的 探讨急诊腹腔镜胆总管探查术(LCBDE)在治疗急性胆管炎超高龄患者中的应用效果.方法 回顾性分析45例行急诊LCBDE的超高龄(≥80岁)胆总管结石继发急性胆管炎患者临床资料,分析患者手术情况、术后并发症情况以及预后.结果 43例患者顺利完成手术,2例中转开腹,成功率为95.6%;手术时间为(132.22±11.53)min,术中出血量为(22.71±5.57)ml,住院时间为(8.13±1.43)d.术后发生急性心力衰竭1例、肺部感染3例,无出血、胆漏、腹腔感染、死亡等严重并发症.随访2~12个月均无结石复发及胆道狭窄.结论 在严格把握适应证及熟练掌握腹腔镜操作技术的前提下,胆总管结石继发急性胆管炎超高龄患者行急诊LCBDE是安全可行的.%Objective To investigate the efficacy of emergency laparoscopic common bile duct exploration ( LCBDE ) applied to the treatment of very elderly patients with acute cholangitis .Methods Clinical data of 45 very elderly ( aged 80 years and older ) patients with acute cholangitis secondary to choledocholithiasis who underwent emergency LCBDE were retrospectively analyzed .The condition of operation, incidence of postoperative complications,and prognosis of the patients were analyzed.Results The operation was successfully completed in 43 cases, two cases were converted to open surgery,and the success rate was 95.6%;the duration of operation was 132.22 ±11.53 minutes,the intraoperative blood loss was 22.71 ±5.57 ml,and the hospital stay was 8.13 ±1.43 days.After operation,acute heart failure occurred in 1 case and pulmonary infection in 3 cases.There were no severe complications such as bleeding ,bile leakage,abdominal infection or death .No stone recurrence or biliary stricture was observed during the follow up of 2 to 12 months.Conclusion It is safe and feasible for very elderly patients with acute cholangitis secondary to choledocholithiasis to undergo emergency LCBDE in the context of surgeon ′s sticking to the indications and mastering the techniques of laparoscopic surgery .