| Objectives:With the aggravation of aging,the proportion of elderly patients with cholelithiasis is increasing year by year.Elderly patients because of their poor physique,progress quickly,and a variety of basic diseases,often lead to the complication and severity of biliary tract diseases.According to WHO’s definition of the elderly and the current situation in China,choose between 60 and 79 years of age.In this study,by comparing the traditional open surgery and double mirror surgery clinical data including laparoscope combined with choledochoscope and digestive endoscopy combined with laparoscopy in patients,through the observation of the successful implementation of the traditional open surgery and double mirror surgery of the sex and age of patients,preoperative underlying disease,operation time,bleeding volume,postoperative pain reaction,postoperative gastrointestinal function recovery time,postoperative ambulation time,postoperative blood index,postoperative body temperature,postoperative hospitalization time,hospitalization expenses and postoperative complications of the clinical data,comparative analysis,to provide theoretical basis for the rational diagnosis and treatment of gallstones and choledocholithiasis in elderly patients.Methods:The clinical data of patients with hepatobiliary pancreatic surgery in Zhengzhou Central Hospital Affiliated to Zhengzhou University were collected,time from January 2014 to January 2017.The patients’ data were all from cholecystolithiasis and choledocholithiasis.By setting the inclusion and exclusion criteria,in accordance with the standards of the patients,age in 124 cases between 60 to 79 years old patients.According to different surgical methods,108 cases were divided into three groups,respectively,the traditional open surgery group(Ⅰ group)and laparoscopic surgery group(Ⅱ group)and duodenoscopy combined with laparoscopy group is first endoscopic sphincterotomy stone basket lithotomy underwent laparoscopic cholecystectomy surgery group(Ⅲ group).According to the sex and age of patients,preoperative underlying diseases,operative time,bleeding volume,postoperative pain,postoperative gastrointestinal function recovery time,postoperative ambulation time,postoperative blood index,postoperative body temperature,postoperative hospitalization time,hospitalization expenses and postoperative.The clinical data of three groups of patients receiving different surgical procedures were analyzed statistically.Results:1.Basic information: there groups were no significant differences in age,sex and preoperative basic diseases.There are no significant difference between the three groups(P > 0.05).2.Intraoperative condition: the time of operation in group Ⅲ was significantly shorter than that in group Ⅰ and group Ⅱ(P < 0.05),and there was no significant difference in bleeding volume between group Ⅱ and Ⅲ(P > 0.05),but all of them were significantly lower than those in Ⅰ group(P < 0.05).3.Recovery after operation: the pain in group Ⅰ patients were significantly higher than that in group Ⅱ and group Ⅲ.Statistical significance(P < 0.05),Ⅱ group and Ⅲ group of patients after the pain reaction had no significant difference(P > 0.05),C group patients were given endoscopic surgery underwent laparoscopic cholecystectomy,underwent 2 surgery treatment,recovery of gastrointestinal function after operation,Ⅱ group and Ⅲ group,the recovery time was significantly lower than that of Ⅰ group,the difference was statistically statistically significant(P < 0.05),The recovery time in group Ⅱ was slightly shorter than that in group Ⅲ(P > 0.05).There was no significant difference in postoperative body temperature and blood indexes such as white blood cell,Ⅲ reactive protein,serum bilirubin and aminotransferase between the three groups(P > 0.05).4.Postoperative complications: Three groups of patients were successfully operated,no death cases.In group Ⅰ,there were 2 cases of incision infection and fat liquefaction after operation,2 weeks after active dressing change and symptomatic treatment,4 cases of pulmonary infection were cured after adjustment for antibiotics and symptomatic treatment,1 cases had mild postoperative bile leakage,and 5 days after patency drainage.In group Ⅱ,there were 2 cases of mild bile leakage after operation,and 1 weeks after conservative treatment.There were 2 cases of mild pancreatitis and 1 cases of biliary tract bleeding after operation in group Ⅲ,and all of them were cured after active treatment.The postoperative complications of the three groups were higher than that of group Ⅱ and group Ⅲ(P < 0.05).There was no significant difference between the two groups in the Ⅱ group and the group Ⅲ(P > 0.05).5.Hospitalization time and cost statistics: hospitalization time after operation in the three groups,it is found that the patients of the Ⅰ group after the hospitalization time was significantly higher than that of Ⅱ group and Ⅲ group,with statistical significance(P < 0.05),Ⅱ group and Ⅲ group,the postoperative hospitalization time close,no significant difference between the difference(P > 0.05).In group Ⅰ,the cost of hospitalization was lower than that of group Ⅱ and group Ⅲ,with statistical significance(P < 0.05).Conclusions:Elderly patients with cholecystolithiasis and choledocholithiasis,strictly grasp the surgical indications,including endoscopy combined with laparoscopy combined with choledochoscopy and twelve duodenal by combined laparoscopic surgery in treatment of elderly patients is a safe,simple,effective and feasible way.Compared with traditional open surgery,treatment with double mirror combined operation has small surgical trauma,less time for operation,less bleeding,postoperative pain reaction and rapid postoperative recovery.And that does not increase the complications after operation,fully embodies the minimally invasive surgical damage.The advantages of quick recovery,in line with modern rapid rehabilitation surgery concept is the preferred scheme in the treatment of elderly patients with cholelithiasis. |
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