發(fā)布時(shí)間：2018-04-20 22:01

  本文選題：膽石病 + 膽道探查��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：膽石病在外科系統(tǒng)中較為常見,高齡是其高危因素,65歲以上的老年人發(fā)病率高達(dá)38%,其中膽管結(jié)石約占10%[1]。由于老年人免疫功能和機(jī)體抵抗力下降,常合并有心、肺、腦等慢性全身性病變,常常病情較重。青年病患可以承受的手術(shù)打擊,可能使老年患者致命。膽管結(jié)石嚴(yán)重威脅患者身心健康,因此,一旦確診,需要立即治療。開腹膽管探查取石是常用的外科治療手段,但值得探討的是取石后是常規(guī)留置T管引流還是直接一期縫合膽管。傳統(tǒng)的觀點(diǎn)是,T管引流可有效降低膽道壓力,避免膽道狹窄,促進(jìn)康復(fù),而且便于術(shù)后T管造影和治療膽道殘余結(jié)石。但術(shù)后T管相關(guān)并發(fā)癥給患者帶來的痛苦是不可避免的,尤其在老年患者中體現(xiàn)更為明顯。近年來,隨著諸多腹腔鏡膽總管探查(Laparoscopic common bile duct exploration LCBDE)后一期縫合的成功報(bào)道,其優(yōu)越性更符合快速康復(fù)外科理念,讓人們質(zhì)疑留置T管的必要性。因此,通過對(duì)比兩種術(shù)式有利于臨床中更好的選擇手術(shù)方案。目的:探討腹腔鏡膽道探查后一期縫合在老年患者中的可行性及應(yīng)用價(jià)值。材料及方法:選擇吉林大學(xué)第一醫(yī)院于2015年11月-2016年11月期間符合標(biāo)準(zhǔn)行腹腔鏡膽道探查取石的老年患者60例,其中30例行腹腔鏡膽道探查一期縫合術(shù)(primary suture,PS組-實(shí)驗(yàn)組,),其余30例行腹腔鏡膽道探查、T形管引流術(shù)(T—tube drainage,TD組-對(duì)照組)。比較兩組手術(shù)時(shí)間、術(shù)中出血量、術(shù)后輸液量、術(shù)后住院時(shí)間、術(shù)后肛門恢復(fù)排氣時(shí)間、住院費(fèi)用、術(shù)后并發(fā)癥(膽瘺、膽道出血、膽道狹窄、結(jié)石復(fù)發(fā)、T管脫落、消化不良等)、肝功恢復(fù)情況(ALT、AST、Tbil、Dbil)等情況。結(jié)果:與TD組相比,PS組患者術(shù)后輸液量大大減少,術(shù)后住院時(shí)間,術(shù)后肛門恢復(fù)排氣時(shí)間均縮短,住院費(fèi)用降低;膽瘺、膽道出血、膽道狹窄、殘余結(jié)石、T管脫落并發(fā)癥與TD組相比無統(tǒng)計(jì)學(xué)差異,但消化功能及肝功能比TD組恢復(fù)更快。結(jié)論:在合適的老年膽總管結(jié)石患者中,腹腔鏡膽道探查后一期縫合是安全可行的,而且能降低治療費(fèi)用,縮短住院時(shí)間,改善患者的生活質(zhì)量,對(duì)患者消化功能、肝功能等恢復(fù)存在優(yōu)勢(shì),更能體現(xiàn)出微創(chuàng)外科的優(yōu)越性。
[Abstract]:Cholelithiasis is common in the surgical system. The incidence of cholelithiasis in the elderly aged over 65 years is as high as 38%, in which bile duct stones account for about 10% [1]. As the immune function and body resistance of the elderly decreased, often accompanied by heart, lung, brain and other chronic systemic diseases, often more serious. The surgical blow that young patients can afford can kill elderly patients. Choledocholithiasis is a serious threat to the patient's physical and mental health, therefore, once diagnosed, it needs immediate treatment. Open bile duct exploration and lithotripsy is a common surgical treatment, but it is worth discussing whether it is a conventional T-tube drainage or a direct primary suture of bile duct after lithotomy. The traditional view is that T-tube drainage can effectively reduce biliary pressure, avoid biliary stricture, promote rehabilitation, and facilitate postoperative T-tube angiography and treatment of residual stones of the biliary tract. However, the pain caused by postoperative T tube-related complications is inevitable, especially in elderly patients. In recent years, with the successful report of one stage suture after laparoscopic common bile duct exploration LCBDEs, its superiority is more in line with the idea of rapid rehabilitation surgery, which makes people question the necessity of indwelling T tube. Therefore, the comparison of the two surgical procedures is beneficial to the better choice of surgical options in clinical practice. Objective: to evaluate the feasibility and value of primary suture after laparoscopic choledochotomy in elderly patients. Materials and methods: sixty elderly patients who met the standard of laparoscopic choledocholithotomy between November 2015 and November 2016 in the first Hospital of Jilin University were selected. Among them, 30 cases were treated with primary suture of primary suture PS and 30 cases with T-tube tube drainage, and 30 cases were treated with T-tube tube drainage, the control group was treated with laparoscope exploration of bile duct in the primary suture group (n = 30), experimental group (n = 30), and the control group (n = 30). The operation time, intraoperative bleeding volume, postoperative transfusion volume, postoperative hospitalization time, postoperative anus recovery time, hospitalization cost, postoperative complications (biliary fistula, biliary bleeding, biliary stricture, stone recurrence and T tube fall off) were compared between the two groups. Dyspepsia and other conditions, recovery of liver function and alt Tbiln Tbiln, and other conditions. Results: compared with TD group, the postoperative infusion volume, postoperative hospitalization time, postoperative anal recovery and exhaust time and hospitalization cost were significantly reduced in PS group. There was no significant difference in the complications of T tube exfoliation of residual stones compared with TD group, but the digestive function and liver function recovered more quickly than that in TD group. Conclusion: in the elderly patients with choledocholithiasis, the primary suture after laparoscopic choledocholithiasis is safe and feasible, and it can reduce the cost of treatment, shorten the hospitalization time, improve the quality of life of the patients, and improve the digestive function of the patients. Recovery of liver function has advantages, which can reflect the superiority of minimally invasive surgery.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.4

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