非重症急性胆管炎患者行腹腔镜胆总管探查一期缝合与T管引流的比较

Comparison of Primary Suture and T-Tube Drainage During Laparoscopic Common Bile Duct Exploration in Patients without Severe Acute Cholangitis

目的:探讨非重症急性胆管炎(AC)患者行腹腔镜胆总管探查(LCBDE)后一期缝合(PC)的安全性和有效性。方法:选取华北理工大学附属河北省人民医院肝胆外科2018年3月至2020年3月就诊的非重症急性胆管炎行LCBDE患者50例的临床与随访资料,比较胆总管一期缝合25例(PC组)和T管引流25例(T管组)相关临床指标。结果:50例患者中,49例均顺利完成手术,1例中转开腹。两组性别、年龄、体重指数(BMI)、美国麻醉医师协会(ASA)分级、急性胆管炎(AC)分级、急性胆囊炎例数、胆总管直径、术前合并症、临床症状与体征方面比较,差异均无统计学意义(P>0.05)。两组术前血清总胆红素(TB)、直接胆红素(DBIL)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷酰转肽酶(GGT)比较,差异无统计学意义(P>0.05)。与T管组相比,PC组手术时间较短,术中出血量较少,腹腔引流时间及术后住院时间较短,差异有统计学意义(t/z/P=6.144/<0.001、2.143/0.032、2.504/0.016、2.561/0.014)。两组患者均无结石残余、术中邻近脏器损伤和住院死亡病例。PC组术后胆瘘、腹腔出血、电解质紊乱、下肢静脉血栓、胸腔积液,恶心呕吐等并发症总发生率与T管组比较差异无统计学意义(χ^(2)=2.228,P=0.136)。随访期间,两组均未出现胆道狭窄,T管组2例患者出现结石复发。结论:非重症AC胆总管结石患者行LCBDE后PC在手术时间、术中出血量、腹腔引流时间、术后住院时间均显示出优于T管组的临床结果,是一种安全、可行的治疗方法。

Objective:To investigate the safety and effectiveness of primary suture(PC)after laparoscopic common bile duct exploration(LCBDE)in patients with non-severe acute cholangitis(AC).Methods:The clinical and follow-up data of 50 patients with non-severe acute cholangitis who underwent LCBDE from March 2018 to March 2020 in the Department of Hepatobiliary Surgery,Hebei Provincial People's Hospital affiliated to North China University of Science and Technology were selected,and the clinical indexes of 25 cases with primary suture of common bile duct(PC groups)and 25 cases with T-tube drainage(T-tube group)were compared.Results:Of the 50 patients,49 cases were successfully operated,and 1 case was converted to laparotomy.There was no significant difference in gender,age,body mass index(BMI),American Association of Anesthesiologists(ASA)grade,acute cholangitis(AC)grade,acute cholecystitis cases,common bile duct diameter,preoperative complications,clinical symptoms and signs between the two groups(P>0.05).There was no significant difference in serum total bilirubin(TB),direct bilirubin(DBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST)and glutamyl transpeptidase(GGT)between the two groups before operation(P>0.05).Compared with T-tube group,PC group had shorter operation time,less intraoperative blood loss,shorter abdominal drainage time and shorter postoperative hospital stay,and the differences were statistically significant(t/z/P=6.144/<0.001,2.143/0.032,2.504/0.016,2.561/0.014).There were no residual stones,injury of adjacent organs during operation and death in hospital in both groups.The total incidence of postoperative complications such as biliary fistula,abdominal hemorrhage,electrolyte disturbance,venous thrombosis of lower limbs,pleural effusion,nausea and vomiting in PC group was not significantly different from that in T-tube group(χ^(2)=2.228,P=0.136).During the follow-up,no biliary stricture occurred in the two groups,and 2 patients in T-tube group had stone recurrence.Conclusion:PC after LCBDE in patients with non-severe AC choledocholithiasis has shown better clinical outcomes than the T-tube group in terms of operative time,intraoperative bleeding,abdominal drainage time and postoperative hospital stay,making it a safe and feasible treatment option.