【摘要】 目的 探讨三种引流方式在老年胆总管结石患者行腹腔镜胆总管探查术后的应用价值。方法 回顾性分析156例行腹腔镜胆总管探查术老年胆总管结石患者的临床资料，根据处理方式的不同把患者分为A、B、C组。A组给予T管引流，B组给予鼻胆管引流并一期缝合，C组给予单猪尾胆道支架置入并一期缝合。对比3组的围手术期指标、炎症指标、生活质量和并发症。结果 C组的胆总管操作时间、手术时间、下床活动时间、术后排气时间、住院时间明显短于A、B组（P<0.01）。与B组相比，A组的手术时间和胆总管操作时间明显短，但术后排气时间、下床活动时间、住院时间明显长（P<0.05或0.01）。C组术后3 d的CRP、PCT、白细胞、IL-6和TNF-α浓度最低、B组次之，A组最高（P<0.05或0.01）。B、C组术后14 d的生理功能评分、精神状态评分、日常生活能力评分、症状学评分、社会活动评分均高于A组（P<0.01）。结论 单猪尾胆道支架置入并一期缝合可改善行腹腔镜胆总管探查术老年胆总管结石患者的围手术期指标，同时可减轻术后炎症反应和提高生活质量。更多还原

【Abstract】 Objective To investigate the value of three drainage methods after laparoscopic common bile duct exploration(LCBDE) in elderly patients with common bile duct stones. Methods Retrospective analysis of clinical data of 156 elderly patients with common bile duct stones treated with LCBDE. According to the postoperative drainage method, patients were divided into groups A(T-tube drainage), B(nasobiliary drainage with primary duct closure), and C(single-pigtail biliary stent placement with primary closure). The perioperative indicators, inflammatory indicators, quality of life, and complications of the three groups were compared. Results Compared with Group C, both Group A and Group B exhibited significantly longer bile duct operation time, surgical time, ambulation time, postoperative exhaust time, and hospitalization time(P < 0.01). When compared with Group B, Group A had significantly shorter surgical time and common bile duct operation time, but longer time to postoperative exhaust, time to ambulation, and hospitalization(P < 0.05 or 0.01). The concentrations of CRP, PCT, white blood cells, IL-6, and TNF-α at 3 days after surgery were lowest in group C, followed by group B, and highest in group A(P < 0.05 or 0.01). At 14 days after surgery, the physiological function score, mental state score, daily living ability score, symptomatology score, and social activity score of Group B and Group C were all higher than those of Group A(P < 0.01). Conclusion In elderly patients undergoing LCBDE for common bile duct stones, single pig tail biliary stent placement with primary suturing is associated with improved perioperative indicators, reduced postoperative inflammatory reactions and better quality of life compared with T-tube or nasobiliary drainage.更多还原