Efficacy of laparoscopic surgery in the treatment of elderly patients with choledocholithiasis and cholecystolithiasis

doi:10.3877/cma.j.issn.2095-3232.2018.04.009

Abstract

Abstract:

Objective

To explore the efficacy and safety of laparoscopic cholecystectomy + laparoscopic common bile duct exploration (LC+LCBDE) in the treatment of elderly patients with choledocholithiasis and cholecystolithiasis.

Methods

Clinical data of 130 patients, aged 80 years and above and with choledocholithiasis and cholecystolithiasis, who were admitted in East China Hospital Affiliated to Fudan University from April 2011 to May 2017 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients were divided into LC+LCBDE group (laparoscopy group) and traditional laparotomy group (laparotomy group) according to different surgical procedure. There were 66 patients in laparoscopy group, including 38 males and 28 females, with an average age of (84±4) years. There were 64 patients in laparotomy group, including 30 males and 34 females, with an average age of (84±4) years. Perioperative indicators such as operation time and amount of bleeding between two groups were compared by t test, and the incidence of complications was compared by Chi-square test or Fisher's exact probability test.

Results

The operations of all the patients were performed successfully. In laparoscopy group, the operation time, postoperative first anus exhaust time and use time of analgesic medication were (105±44) min, (2.2±0.8) d and (2.4±1.3) d, which were significantly shorter than (121±39) min, (3.2±1.5) d and (3.2±1.5) d in laparotomy group (t=-2.175, -4.072, -3.397; P<0.05). The incidence of pulmonary infection in laparoscopy group was 3%(2/66), which was significantly lower than 14%(9/64) in laparotomy group (χ²=5.106, P<0.05). 1 case in laparoscopy group and 3 cases in laparotomy group died within 30 d after operation, where no significant difference was observed (χ²=0.291, P>0.05).

Conclusions

Advanced age is not a contraindication for laparoscopic operation. With the positive and reasonable perioperative management, LC+LCBDE is feasible, effective and safe for the elderly patients with choledocholithiasis and cholecystolithiasis. It can effectively shorten the operation time, accelerate the recovery, reduce postoperative pain and incidence of postoperative complications.

Key words: Aged, Choledocholithiasis, Cholecystolithiasis, Laparoscopes

Jianhua Cai, Jiaqi He, Chongyi Jiang, Yun Liang, Meng Liu, Wei Wang. Efficacy of laparoscopic surgery in the treatment of elderly patients with choledocholithiasis and cholecystolithiasis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2018, 07(04): 289-294.

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References 21

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临床参数		腔镜组	开腹组	统计值	P值
年龄（岁，±s）		84±4	84±4	t=-0.144	0.886
性别（男/女，例）		38/28	30/34	χ²=1.491	0.222
BMI（kg/m²，±s）		23±4	23±4	t=0.151	0.880
上腹部手术史（例）		10	8	χ²=0.191	0.662
ERCP史（例）		5	3	χ²=0.469	0.493
合并疾病（例）		?	?	?	?
?	高血压	39	22	χ²=7.970	0.005
?	糖尿病	9	10	χ²=0.103	0.748
?	冠心病	13	11	χ²=0.136	0.712
?	COPD	8	8	χ²=0.004	0.948
?	2种以上	17	14	χ²=0.270	0.604
Charcot三联征（例）		10	14	χ²=0.976	0.323
ASA评分（分，±s）		2.2±0.5	2.3±0.5	t=-0.777	0.439
急诊手术（例）		3	13	χ²=7.484	0.006

临床参数		腔镜组	开腹组	统计值	P值
年龄（岁，±s）		84±4	84±4	t=-0.144	0.886
性别（男/女，例）		38/28	30/34	χ²=1.491	0.222
BMI（kg/m²，±s）		23±4	23±4	t=0.151	0.880
上腹部手术史（例）		10	8	χ²=0.191	0.662
ERCP史（例）		5	3	χ²=0.469	0.493
合并疾病（例）		?	?	?	?
?	高血压	39	22	χ²=7.970	0.005
?	糖尿病	9	10	χ²=0.103	0.748
?	冠心病	13	11	χ²=0.136	0.712
?	COPD	8	8	χ²=0.004	0.948
?	2种以上	17	14	χ²=0.270	0.604
Charcot三联征（例）		10	14	χ²=0.976	0.323
ASA评分（分，±s）		2.2±0.5	2.3±0.5	t=-0.777	0.439
急诊手术（例）		3	13	χ²=7.484	0.006

临床参数	腔镜组	开腹组	统计值	P值
手术时间（min，±s）	105±44	121±39	t=-2.175	0.031
术中出血量[ml，M（Q_R）]	19(5～200)	90(10～600)	Z=-8.291	0.000
胆总管一期缝合（例）	8	0	-	0.004
胆总管结石数量（单/多枚，例）	21/45	21/43	χ²=0.015	0.904
胆总管直径（mm，±s）	12±3	17±6	t=-5.308	0.000
胆总管结石最大径[mm，M（Q_R）]	17.5(2.0～30.0)	11.2(2.0～40.0)	Z=-3.597	0.000
术后首次肛门排气时间（d，±s）	2.2±0.8	3.2±1.5	t=-4.072	0.000
腹腔引流管留置时间[d，M（Q_R）]	3.7(2.0～9.0)	4.9(0～45.0)	Z=-3.207	0.001
留置尿管（例）	47	60	χ²=11.334	0.001
留置尿管时间[d，M（Q_R）]	4.3(1.0～26.0)	5.7(0～44.0)	Z=-2.825	0.005
留置胃管（例）	6	45	χ²=51.083	0.000
胃管拔除时间[d，M（Q_R）]	2.3(1.0～3.0)	2.4(0～11.0)	Z=-0.516	0.606
术后止痛药物使用时间（d）	2.4±1.3	3.2±1.5	t=-3.397	0.001
术后住院时间[d，M（Q_R）]	7(4～50)	13(1～58)	Z=-5.986	0.000
住院总费用[万元，M（Q_R）]	2.8(1.1～33.3)	3.8(1.4～16.8)	Z=-2.077	0.038
ICU治疗（例）	8	16	χ²=3.580	0.058

临床参数	腔镜组	开腹组	统计值	P值
手术时间（min，±s）	105±44	121±39	t=-2.175	0.031
术中出血量[ml，M（Q_R）]	19(5～200)	90(10～600)	Z=-8.291	0.000
胆总管一期缝合（例）	8	0	-	0.004
胆总管结石数量（单/多枚，例）	21/45	21/43	χ²=0.015	0.904
胆总管直径（mm，±s）	12±3	17±6	t=-5.308	0.000
胆总管结石最大径[mm，M（Q_R）]	17.5(2.0～30.0)	11.2(2.0～40.0)	Z=-3.597	0.000
术后首次肛门排气时间（d，±s）	2.2±0.8	3.2±1.5	t=-4.072	0.000
腹腔引流管留置时间[d，M（Q_R）]	3.7(2.0～9.0)	4.9(0～45.0)	Z=-3.207	0.001
留置尿管（例）	47	60	χ²=11.334	0.001
留置尿管时间[d，M（Q_R）]	4.3(1.0～26.0)	5.7(0～44.0)	Z=-2.825	0.005
留置胃管（例）	6	45	χ²=51.083	0.000
胃管拔除时间[d，M（Q_R）]	2.3(1.0～3.0)	2.4(0～11.0)	Z=-0.516	0.606
术后止痛药物使用时间（d）	2.4±1.3	3.2±1.5	t=-3.397	0.001
术后住院时间[d，M（Q_R）]	7(4～50)	13(1～58)	Z=-5.986	0.000
住院总费用[万元，M（Q_R）]	2.8(1.1～33.3)	3.8(1.4～16.8)	Z=-2.077	0.038
ICU治疗（例）	8	16	χ²=3.580	0.058

术后并发症	腔镜组	开腹组	χ²值	P值
切口感染	1（2）	5（8）	1.671	0.196
胆道感染	3（5）	1（2）	0.227	0.634
肺部感染	2（3）	9（14）	5.106	0.024
结石残余	1（2）	1（2）	0	1.000
胆漏	0（0）	2（3）	-	0.463
术后30 d内死亡	1（2）	3（5）	0.291	0.590^a

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