CAJ | 학술논문

目的探讨超高龄肝胆管结石病患者手术治疗的疗效.方法回顾性分析2009年1月至2012年10月唐山市开滦总医院收治的196例超高龄(≥80岁)肝胆管结石病患者的临床资料.196例肝胆管结石病患者均行手术治疗.术后采用电话和门诊复诊方式进行随访,随访时间截至2013年5月.结果入院后24 h内行急诊手术58例,其余138例患者平均入院7.4 d(1.0～18.0 d)后施行手术.50例患者行腹腔镜手术,其中胆囊切除+胆总管切开取石+T管引流术43例、胆总管切开取石+T管引流术7例;146例患者施行开腹手术,其中胆囊切除+胆总管切开取石+T管引流术78例、胆总管切开取石+T管引流术43例、胆总管切开取石+T管引流+肝部分切除术25例.全组患者手术时间为(78±16) min,术中出血量为15 ～300 mL.治愈194例;死亡2例;术后37例患者出现并发症,并发症发生率为18.88％(37/196).163例患者获得随访,随访率为83.16％ (163/196),中位随访时间为26个月(7～ 52个月).12例患者术后结石复发,结石复发率为7.36％ (12/163).结论对于超高龄肝胆管结石病患者,选择合理手术方式,其手术治愈率高,术后并发症发生率低,结石复发率低,可取得较理想的临床疗效.
목적 탐토초고령간담관결석병환자수술치료적료효.방법 회고성분석2009년1월지2012년10월당산시개란총의원수치적196례초고령(≥80세)간담관결석병환자적림상자료.196례간담관결석병환자균행수술치료.술후채용전화화문진복진방식진행수방,수방시간절지2013년5월.결과 입원후24 h내행급진수술58례,기여138례환자평균입원7.4 d(1.0～18.0 d)후시행수술.50례환자행복강경수술,기중담낭절제+담총관절개취석+T관인류술43례、담총관절개취석+T관인류술7례;146례환자시행개복수술,기중담낭절제+담총관절개취석+T관인류술78례、담총관절개취석+T관인류술43례、담총관절개취석+T관인류+간부분절제술25례.전조환자수술시간위(78±16) min,술중출혈량위15 ～300 mL.치유194례;사망2례;술후37례환자출현병발증,병발증발생솔위18.88％(37/196).163례환자획득수방,수방솔위83.16％ (163/196),중위수방시간위26개월(7～ 52개월).12례환자술후결석복발,결석복발솔위7.36％ (12/163).결론 대우초고령간담관결석병환자,선택합리수술방식,기수술치유솔고,술후병발증발생솔저,결석복발솔저,가취득교이상적림상료효.
Objective To investigate the efficacy of surgical treatment for hepatolithiasis in patients of advanced age.Methods The clinical data of 196 patients of advanced age (≥80 years) and with hepatolithiasis who were admitted to the Kailuan General Hospital from January 2009 to October 2012 were retrospectively analyzed.All the 196 patients received surgical treatment.Patients were followed up via phone call or out-patient examination till May 2013.Results Fifty-eight patients received emergent operation within 24 hours after admission,and the other 138 patients received operation 7.4 days (range,1.0-18.0 days) after admission.Fifty patients received laparoscopic surgery,including 43 received cholecystectomy + choledocholithotomy + T tube drainage,7 received choledocholithotomy + T tube drainage.One hundred and forty-six patients received open surgery,including 78 received cholecystectomy + choledocholithotomy + T tube drainage,43 received choledocholithotomy + T tube drainage and 25 received choledocholithotomy + T tube drainage + partial hepatectomy.The operation time was (78 ± 16)minutes,and the volume of intraoperative bleeding ranged between 15 mL and 300 mL.One hundred and ninety-four patients were cured and 2 patients died.Thirty-seven patients had complications after operation,with the morbidity of 18.88％ (37/196).A total of 163 patients were followed up,with the follow-up rate of 83.16％ (163/196).The median time of follow-up was 26 months (range,7-52 months).Twelve patients had hepatolithiasis recurrence,and the recurrence rate was 7.36％ (12/163).Conclusion Surgical treatment for hepatolithiasis in patients of advanced age has the advantages of high cure rate,low incidence of complications and recurrence,and the clinical efficacy is satisfactory.