Clinical observation of laparoscopic cholecystectomy combined with common bile duct exploration in the treatment of elderly patients with cholecystolithiasis and common bile duct stones
Objective To explore the clinical effect of laparoscopic cholecystectomy(LC)combined with common bile duct exploration in the treatment of elderly patients with cholecystolithiasis and common bile duct stones(CCWC)and its influence on liver function and inflammatory stress response.Methods Eighty-six elderly patients with CCWC were divided into two groups according to different surgical methods,with 43 cases in each group.There were no differences in clinical baseline data between the two groups,such as gender,age,BMI,course of disease,ASA classification,maxi-mum stone diameter and common bile duct diameter.Patients in the observation group was treated with LC combined with laparoscopic common bile duct exploration(LCBDE),while patients in the control group were treated with endoscopic ret-rograde cholangiopancreatography(ERCP)/ESC combined with LC.The perioperative conditions(operation time,intraop-erative blood loss,postoperative exhaust time,and hospitalization time)and clinical efficacy(incidence of complications,residual rate of stones and recurrence rate)of the two groups were observed.Serum total bilirubin(TBil),aspartate trans-ferase(AST),alanine transferase(ALT),tumor cell necrosis factor-α(TNF-α)and C-reactive protein(CRP)were detected before and 3 days after operation.Results Compared with the control group,the operation time,postoperative exhaust time and hospitalization time in the observation group were shortened,and the amount of bleeding during the opera-tion was reduced,with statistically significant differences between the two groups(all P<0.05).There were no significant differences in stone residual rate or recurrence rate between the two groups(both P>0.05).The recurrence rate was lower in the observation group than in the control group,with statistically significant difference between the two groups(P<0.05).The serum TBil,AST and ALT levels decreased,and serum TNF-α,CRP,IL-6,Cor and NE levels increased in the two groups at three days after operation in comparison with those before operation(all P<0.05).Compared with the control group,the serum levels of TNF-α,CRP,IL-6,Cor and NE in the observation group decreased at three days after operation(all P<0.05).Conclusions The calculi removal effect of LC+LCBDE and ERCP/ESC+LC in the treatment of CCWC in the elderly patients is similar,and both can improve liver function.However,LC+LCBDE has fewer postopera-tive complications,and less impact on inflammation and stress response in elderly patients.
cholecystolithiasiscalculus of common bile ductminimally invasive surgeryliver functionstress re-sponsethe elderly
万方数据
维普
