老年患者行腹腔镜下胆总管探查一期缝合的可行性研究-现代医学

老年患者行腹腔镜下胆总管探查一期缝合的可行性研究

单位：东南大学附属中大医院肝胆胰中心, 江苏南京 210009

分类号：R657.4

出版年·卷·期（页码）：2025·53·第七期（1110-1114）

摘要：

目的：观察腹腔镜下胆总管探查术(LCBDE)一期缝合治疗老年患者胆总管结石的疗效及可行性。方法：回顾分析东南大学附属中大医院肝胆胰中心单一医疗组2018年9月至2024年8月接受腹腔镜下胆总管探查一期缝合术的130例患者的临床资料，130例患者分为47例≥65岁的老年患者组和83例<65岁的非老年患者组，通过比较两组患者一般资料、手术及术后情况(手术时间、术后住院天数、术后并发症发生率、结石再发率)，分析老年患者行LCBDE一期缝合的安全性和可行性。结果：老年患者组与非老年患者组相比，合并症数量、ASA分级、上腹部手术史、白蛋白、总胆红素、胆总管直径均有明显的差异。两组患者手术时间、术中出血量、术后住院天数、术后并发症率、围手术期再手术率、术后结石再发率均无明显差异。但老年患者组有4人术后需要转ICU监护，与非老年患者组相比有明显差异(P=0.03)。结论：在严格掌握手术适应症的情况下对老年患者行LCBDE一期缝合是安全可行的。

Objective: To observe the efficacy and feasibility of primary closure following laparoscopic common bile duct exploration(LCBDE)for elderly patients with common bile duct stones.Methods: A retrospective analysis was conducted on the clinical data of 130 patients who underwent primary closure following LCBDE from September 2018 to August 2024 in Hepatobiliary and Pancreatic Center, Zhongda Hospital Affiliated to Southeast University. The patients were divided into two groups: 47 elderly patients aged 65 and above and 83 patients under 65. General data as well as surgical and postoperative outcomes were compared to analyze the safety and feasibility of LCBDE primary suture in elderly patients. Results: There were no significant differences between the two groups in terms of gender, WBC, and neutrophil ratio. Compared to the non-elderly group, the elderly group showed significant differences in the number of comorbidities, ASA classification, history of upper abdominal surgery, albumin level, total bilirubin level, and common bile duct diameter. There were no significant differences in operation time, intraoperative blood loss, postoperative hospital stay, postoperative complication rate, perioperative reoperation rate, and postoperative stone recurrence rate between the two groups. However, 4 patients in Group A required ICU monitoring postoperatively, showing a significant difference compared to Group B(P=0.03).Conclusion: Performing primary closure following LCBDE in elderly patients is safe and feasible when surgical indications are strictly controlled.

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