陈聪 安代红 陶锐

【摘要】 目的：探讨ERCP联合LC在老年胆囊结石合并胆总管结石的安全性和有效性。方法：回顾性分析2013年1月-2019年9月在本院同一次住院期间先后进行ERCP和LC的68例胆囊结石合并胆总管结石老年患者进行临床资料。根据年龄将患者分为高龄组（≥75岁）和老年组（≥65岁且<75岁），高龄组31例，老年组37例。比较两组并发症发生情况及手术指标。结果：两组均无死亡病例及30 d内再住院病例。高龄组一次性结石取尽率、LC手术时间、中转开腹率、出血量分别为93.5%、（56.32±19.35） min、0、10.00（5.00，10.00） mL均低于老年组的97.3%、（61.08±33.46） min、5.41%、12.89（10.00，10.00） mL，差异均无统计学意义（P>0.05）。高龄组ERCP手术时间、LC术后住院时间、ERCP和LC间隔时间分别为（44.58±14.43） min、（5.64±2.09） d、（3.74±1.71） d均长于老年组的（41.73±14.76） min、（5.14±1.75） d、（3.31±1.67） d，但差异均无统计学意义（P>0.05）。两组均无术后出血和穿孔发生。高龄组ERCP术后急性胰腺炎发生率为9.7%高于老年组的5.4%，高龄组LC术后肺部感染、呼吸机脱机延迟发生率均为0，均低于老年组的2.7%和5.4%，差异均无统计学意义（P>0.05）。結论：对于存在胆囊结石和胆总管结石的老年患者，在同一次住院期间内完成ERCP和LC是安全、可行的。

【关键词】 内镜逆行胰胆管造影术 腹腔镜胆囊切除术 胆囊结石 胆总管结石

Application of ERCP Combined with Laparoscopic Cholecystectomy in Elderly Patients with Cholecystolithiasis Complicated with Choledocholithiasis/CHEN Cong， AN Daihong， TAO Rui. //Medical Innovation of China， 2021， 18（28）： 129-133

[Abstract] Objective： To investigate the safety and efficacy of ERCP combined with LC in elderly patients with cholecystolithiasis complicated with choledocholithiasis. Method： Clinical data of 68 elderly patients with cholecystolithiasis complicated with choledocholithiasis who underwent ERCP and LC successively during the same hospitalization period from January 2013 to September 2019 in our hospital were retrospectively analyzed. According to age， patients were divided into the old elderly group （≥75 years old） and the young elderly group （≥65 years old and <75 years old）， with 31 cases in the old elderly group and 37 cases in the young elderly group. The incidence of complications and surgical indicators were compared between two groups. Result： There were no death or rehospitalization within 30 d in both groups. The one-time stone extraction rate， LC surgical time， conversion rate and blood loss in the old elderly group were 93.5%， （56.32±19.35） min， 0， 10.00 （5.00， 10.00） mL， respectively， which were lower than 97.3%， （61.08±33.46） min， 5.4%， 12.89 （10.00， 10.00） mL in the young elderly group， but the differences were not statistically significant （P>0.05）. ERCP surgical time， postoperative hospital stay， ERCP and LC interval in the old elderly group were （44.58±14.43） min， （5.64±2.09） d， （3.74±1.71） d， respectively， which were longer than （41.73±14.76） min， （5.14±1.75） d， （3.31±1.67） d in the young elderly group， but the differences were not statistically significant （P>0.05）. No postoperative bleeding and perforation occurred in both groups. The incidence of postoperative acute pancreatitis in the old elderly group was 9.7%， which was higher than 5.4% in the young elderly group， the incidence of postoperative pulmonary infection and ventilator offline delay after LC in the old elderly group were 0， which were lower than 2.7% and 5.4% in the young elderly group， the differences were not statistically significant （P>0.05）. Conclusion： Combination of ERCP and LC is safe and feasible for the elder patients with cholecystolithiasis complicated with choledocholithiasis in same hospitalization.

[Key words] EPCP Laparoscopic cholecystectomy Cholecystolithiasis Choledocholithiasis

First-author’s address： Bishan Hospital， Chongqing 402760， China

doi：10.3969/j.issn.1674-4985.2021.28.032

胆囊结石是我国常见的胆道疾病之一，且发病率随着年龄的增加逐渐增高。约30%大于70岁的老年人存在胆囊结石，其中10%～20%的胆囊结石又常常合并胆总管结石[1]。胆总管结石一旦确诊，均建议积极手术，避免因结石梗阻而出现重症胆管炎、感染性休克等情况[2]。由于老年人身体机能随着年龄的增加逐渐减退，且易合并基础疾病，在选择手术策略时，有效性、安全性和微创性就十分重要。……