目的 探讨腹腔镜胆总管探查一期缝合在老年胆囊结石合并胆总管结石病人治疗中的安全性和可行性.方法 回顾性分析63例胆囊结石合并胆总管结石老年病人(≥65岁)行腹腔镜联合胆道镜胆总管探查一期缝合术的手术资料与随访资料.结果 本组63例腹腔镜联合胆道镜行胆总管探查取石手术均顺利完成,无1例中转开腹,手术时间43～ 164 min,平均(79.8±20.5)min;出血量10～ 150 mL,平均(24.4±21.1)mL;术后住院时间3～15d,平均(6.6±1.9)d;发生胆漏6例,再次手术1例.术后随访3 ～48个月,残余胆总管结石1例.结论 腹腔镜联合胆道镜胆总管探查一期缝合术具有创伤小、恢复快的优势,在严格把握手术指征、熟练掌握胆道镜操作、镜下精细缝合前提下,应用于老年胆囊结石合并胆总管结石病人是安全可行的.%Objective To investigate the safety and feasibility of laparoscopic common bile duct exploration (LCBDE) with primary closure for management of choledocholithiasis in elderly patients.Methods The clinical data of 63 elderly patients (≥65 years) with gallbladder stones complicated with choledocholithiasis who were undergone LCBDE and primary closure from July 2012 to July 2016 were retrospectively analyzed.Results LCBDE and primary closure of all the 63 cases were successfully completed.The operative time was 43-164 (79.8 ±20.5) min,the blood loss was 10-150 (24.4 ±21.1) mL,postoperative hospital stay was 3-15 (6.6 ± 1.9) d.Six cases suffered from bile leakage and one of them received second operation.During the follow-up of 3 to 48 months,residual common bile duct stones presented in 1 case.Conclusion LCBDE with primary closure has the advantages of minimal invasion and rapid recovery.It is safe and feasible to treat the elderly patients with common bile duct stones under the premise of strict surgical indications,skilled laparoscopic procedures and accurate endoscopic suture techniques.
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