胆总管结石腹腔镜胆总管探查术后一期缝合与T管引流的临床比较

Primary closure versus T-tube drainage following laparoscopic common bile duct exploration for choledocholithiasis

目的:比较胆总管结石腹腔镜胆总管探查术(LCBDE)后一期缝合与T管引流的临床疗效。方法:回顾分析2012年1月—2014年12月接受LCBDE的142例胆总管结石患者临床资料,其中一期缝合75例,放置T管引流67例,比较两种方式的相关临床指标并分析术后并发症的危险因素。结果:两种手术方式患者间,术前指标除性别有所差异外(P=0.028),其余均无统计学差异(均P>0.05);手术时间、术后并发症发生率、手术死亡率、结石复发率均无统计学差异(均P>0.05),一期缝合患者术后住院时间明显低于放置T管患者(P<0.05)。两种手术方式的主要并发症均为胆瘘,其中一期缝合者发生7例(9.3%),T管引流者发生8例(11.9%);比较胆瘘患者与无胆瘘患者间相关因素,未发现术后胆瘘相关风险因素(均P>0.05)。结论:LCBDE后一期缝合治疗胆总管结石安全有效,其效果与放置T管引流相似且术后住院时间明显缩短。胆瘘的相关风险因素还有赖于大样本的数据资料及前瞻性随机对照研究确定。

Objective： To compare the clinical efficacy of primary closure versus T-tube drainage after laparoscopic common bile duct exploration （LCBDE） for common bile duct stones. Methods： The clinical data of 142 patients with common bile duct stones undergoing LCBDE from January 2012 to December 2014 were retrospectively analyzed. Of the patients, 75 cases received primary closure of the common bile duct and 67 patients were subjected to T-tube drainage after choledochotomy. The relevant clinical variables between the two procedures were compared, and the risk factors for postoperative complications were also analyzed. Results： Between patients undergoing the two different procedures, all preoperative variables, except the gender ratio that was of a statistical difference （P=0.028）, exhibited no significant difference （all P〉0.05）; theoperative time, and incidence of postoperative complications, surgical death and stone recurrence also showed no significant difference （all P〉0.05）, but the length of postoperative hospital stay in patients undergoing primary closure was significantly shorter than that in patients undergoing T-tube drainage （P〈0.05）. Biliary fistula was the main postoperative complication for either procedure, which occurred in 7 cases （9.3%） in patients undergoing primary closure and in 8 cases （11.9%） in those undergoing T-tube drainage, respectively. No risk factors for postoperative biliary fistula was detected by comparison of the relevant variables between patients with and without postoperative biliary fistula （all P〉0.05）. Conclusion： LCBDE with primary closure of the common bile duct is an effective and safe procedure for common bile duct stones, and it has similar clinical efficacy but reduced length of postoperative hospital stay compared with post-LCBDE T-tube drainage. The determination of risk factors for biliary fistula still requires big data analyses and further randomized controlled trials.