老年胆总管结石合并2型糖尿病患者多学科协作模式下行腹腔镜胆总管探查术的疗效分析

林滔　刘仁贵　何晓明　王少博

[摘要] 目的 探討老年胆总管结石合并2型糖尿病患者在多学科协作模式（MDT）下行腹腔镜胆总管探查术的安全性及临床效果。 方法 选取2014年12月～2016年12月期间在我科行腹腔镜下胆囊切除+胆总管探查取石术的患者98例，其中年龄大于60岁合并2型糖尿病患者46例为实验组，年龄小于60岁且未合并糖尿病的患者52例为对照组。比较两组手术时间、术中出血量、术后住院时间及并发症发生率。 结果 98例患者均治愈出院，无死亡病例。实验组住院时间大于对照组（P<0.05），两组在手术时间、术中出血量及并发症方面比较，差异无统计学意义（P>0.05）。 结论 老年胆总管结石合并2型糖尿病的患者在多学科协作模式下控制好血糖及相关基础疾病，行腹腔镜下胆总管探查取石术效果良好，可以达到与年龄小于60岁且未合并糖尿病的患者一样的治疗效果，是安全、有效且微创的一种手术方式。

[关键词] 老年；胆总管结石；2型糖尿病（T2DM）；多学科协作模式（MDT）；临床疗效

[中图分类号] R587.1；R657.4 [文献标识码] A [文章编号] 1673-9701（2018）10-0017-04

Analysis of the curative effect of multi-disciplinary collaboration mode of laparoscopic common bile duct exploration in elderly patients with common bile duct stones and type 2 diabetes mellitus

LIN Tao1 LIU Rengui2 HE Xiaoming2 WANG Shaobo2

1.Clinical Medical College of Dali University in Yunnan Province， Dali 671000， China； 2.Ward 2 of Department of General Surgery， the Affiliated Hospital of Dali University， Dali 671000， China

[Abstract] Objective To investigate the safety and clinical effect of laparoscopic common bile duct exploration in patients with common bile duct stones and type 2 diabetes in multidisciplinary cooperation（MDT）. Methods A total of 98 patients undergoing laparoscopic cholecystectomy+common bile duct exploration from December 2014 to December 2016 were enrolled. Among them， 46 patients older than 60 combined with type 2 diabetes mellitus were selected as the experimental group， with an age less than 60 Fifty-two elderly patients without diabetes were selected as control group. The operation time， intraoperative blood loss， postoperative hospital stay and complication rate were compared between the two groups. Results 98 patients were cured， no deaths. The length of stay in the experimental group was longer than that in the control group（P<0.05）. There was no significant difference between the two groups in operation time，intraoperative blood loss and complications（P>0.05）. Conclusion In elderly patients with common bile duct stones and type 2 diabetes control in patients with multi-disciplinary mode of blood sugar and related underlying diseases， laparoscopic common bile duct exploration and stone surgery is good， can reach the same age and younger than 60 years without diabetes and patients The treatment effect is safe， effective and minimally invasive surgical approach.

[Key words] Elderly； Common bile duct stones； Type 2 diabetes mellitus（T2DM）； Multidisciplinary collaborative modality （MDT）； Clinical efficacy

临床上胆管结石是指肝内外胆管中形成了结石，属于胆道系统中常见的疾病之一，按照结石位置可以划分成肝内胆管结石、肝外胆管结石。其中肝外胆管结石主要处在胆总管下端，相较于肝内的胆管结石而言，肝外胆管结石有较高病发率，尤其在年龄较大人群中比较容易发病[1]。而老年患者经常会伴有不同的慢性病，我国是糖尿病大国，糖尿病患者已达1亿以上，老年糖尿病患者已接近糖尿病患者的50%[2]。而我国以2型糖尿病为主，因此老年胆总管结石在合并2型糖尿病的情况下，因本身各器官生理功能衰退、免疫力低下，使得围手术期更加容易引起代谢紊乱，使病情恶化、术后并发症多、手术死亡率高。……