目的：探讨老年胆总管结石患者行腹腔镜胆总管探查（LCBDE）一期缝合的安全性与有效性。方法：回顾性分析2012年12月—2016年12月期间收治的146例胆囊结石合并胆总管结石行LCBDE一期缝合患者的临床与随访资料，根据年龄分两组，61例≥65岁者为老年组，85例<65岁为非老年组。比较两组患者的相关临床指标。结果：146例患者LCBDE一期缝合手术均顺利完成，无中转开腹。与非老年组比较，老年组手术时间（90.98 min vs. 93.12 min）、术中出血量（25.08 mL vs. 24.94 mL）、胆总管结石数（2.36个vs. 1.98个）差异均无统计学意义（均P>0.05），术后腹腔引流时间（4.74 d vs. 4.13 d）、下床时间（1.87 d vs. 1.61 d）、胃肠功能恢复时间（2.43 d vs. 2.05 d）、住院时间（7.46 d vs. 6.62 d）明显延长（均P<0.05）。两组均无严重并发症发生，两组术后胆汁漏（9.8% vs. 9.4%）、术后腹腔出血（1.6% vs. 2.4%）、残余结石（1.6% vs. 1.2%）、结石复发率（1.6% vs. 0）差异均无统计学意义（均P>0.05）。结论：LCBDE一期缝合处理老年胆总管结石安全、有效，在准确把握手术指证前提下，可作为老年胆总管结石患者优先选择的术式。
Clinical efficacy of laparoscopic common bile duct exploration with primary closure for choledocholithiasis in elderly patients
Objective: To investigate the safety and effectiveness of laparoscopic common bile duct exploration (LCBDE) with primary closure in treatment of choledocholithiasis in elderly patients. Methods: The clinical and follow-up data of 146 patients with gallbladder stones and concomitant choledocholithiasis undergoing LCBDE with primary closure from December 2012 to December 2016 were retrospectively analyzed. The patients were divided into two groups according to their age, with 61 cases ≥65 years old in elderly group and 85 cases <65 years old in non-elderly group. The main clinical variables between the two groups of patients were compared. Results: LCBDE with primary closure was uneventfully completed in all the 146 patients, without any open conversion. In elderly group versus non-elderly group, the operative time (90.98 min vs. 93.12 min), intraoperative blood loss (25.08 mL vs. 24.94 mL) and number of stones in the common bile duct (2.36 vs. 1.98) showed no statistical difference (all P>0.05), but the postoperative drainage time (4.74 d vs. 4.13 d), time to ambulation (1.87 d vs. 1.61 d), time for bowel function recovery (2.43 d vs. 2.05 d) and length of hospital stay (7.46 d vs. 6.62 d) were significantly prolonged (all P<0.05). No serious complications occurred in either of the groups, and no significant differences were noted in incidence of bile leakage (9.8% vs. 9.4%), abdominal bleeding (1.6% vs. 2.4%), residual stone rate (1.6% vs. 1.2%) and stone recurrence rates (1.6% vs. 0) between the two groups (all P>0.05). Conclusion: LCBDE with primary closure is safe and effective in treatment of choledocholithiasis in elderly patients, and can be used as a preferable surgical procedure for elderly patients with choledocholithiasis under adherence to strict surgical indications.