Niu Xiaojuan, Song Jinghai, He Xiuwen, Chen Jian, Xu Jingyong, Li Zhe, Long Haikong, Wei Junmin
Department of General Surgery, Beijing Hospital, National Center of Gerontology, China, No.1, Dahua Road, Dong Dan, Dongcheng District, Beijing, 100730 China.
Indian J Surg. 2018 Jun;80(3):227-232. doi: 10.1007/s12262-016-1574-y. Epub 2016 Dec 23.
Common bile duct (CBD) stones are common in elderly patients. The laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration (LTM-CBDE) is a modified laparoscopic transcystic approach. Its safety and efficacy have not been studied in elderly patients with secondary choledocholithiasis. This study evaluates the safety and efficacy of LTM-CBDE in elderly (≥65 years) patients with secondary choledocholithiasis and compares the results with those in younger patients. In this retrospective analysis, 128 patients underwent LTM-CBDE from March 2007 to December 2013. The patients were divided into two groups according to age: the elderly group consisted of 50 patients aged ≥65 years and the younger group consisted of 78 patients aged <65 years. The preoperative morbidity rate, American Society of Anesthesiologists (ASA) score, previous abdominal operations, operation time, postoperative hospital stay, open conversion rate, postoperative complication rate, residual stone rate, recurrence rate and mortality were compared in both groups. The preoperative morbidity (41 vs. 28) and ASA score (2.5 ± 0.7 vs. 1.8 ± 0.6) were higher in the elderly group ( = 0.000, in both groups). No significant differences in previous abdominal operations, operation time, postoperative hospital stay, open conversion rate, postoperative complication rate, residual stone rate, recurrence rate and mortality ( > 0.05) were found between the two groups from March 2007 to December 2013. LTM-CBDE is a safe and effective treatment procedure for elderly patients with secondary choledocholithiasis. For suitable patients, we recommend LTM-CBDE as the treatment of choice.
胆总管结石在老年患者中很常见。在胆总管探查术中采用腹腔镜经胆囊管汇合部微切口经胆囊管途径（LTM-CBDE）是一种改良的腹腔镜经胆囊管途径。其安全性和有效性尚未在老年继发性胆总管结石患者中进行研究。本研究评估LTM-CBDE在老年（≥65岁）继发性胆总管结石患者中的安全性和有效性，并将结果与年轻患者进行比较。在这项回顾性分析中，2007年3月至2013年12月期间，128例患者接受了LTM-CBDE。根据年龄将患者分为两组：老年组由50例年龄≥65岁的患者组成，年轻组由78例年龄<65岁的患者组成。比较两组患者的术前发病率、美国麻醉医师协会（ASA）评分、既往腹部手术史、手术时间、术后住院时间、中转开腹率、术后并发症发生率、残余结石率、复发率和死亡率。老年组的术前发病率（41比28）和ASA评分（2.5±0.7比1.8±0.6）更高（两组均P = 0.000）。2007年3月至2013年12月期间，两组在既往腹部手术史、手术时间、术后住院时间、中转开腹率、术后并发症发生率、残余结石率、复发率和死亡率方面均未发现显著差异（P>0.05）。LTM-CBDE是老年继发性胆总管结石患者安全有效的治疗方法。对于合适的患者，我们推荐LTM-CBDE作为首选治疗方法。
