腹腔镜胆总管切开取石术后一期缝合与T管引流的比较

Primary closure versus T-tube drainage after laparoscopic choledochotomy for common bile duct stones.

作者信息

Ha J P Y, Tang C N, Siu W T, Chau C H, Li M K W

机构信息

Department of Surgery, Pamela Youde Eastern Nethersole Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, SAR, China.

出版信息

Hepatogastroenterology. 2004 Nov-Dec;51(60):1605-8.

PMID:15532787

Abstract

BACKGROUND/AIMS: To demonstrate the safety and feasibility of primary closure of the common bile duct (CBD) after laparoscopic choledochotomy in patients with CBD stones. Traditionally, the CBD is closed with T-tube drainage after choledochotomy and removal of CBD stones. However, the insertion of a T-tube is not without complication and the patients have to carry it for several weeks before removal. In the laparoscopic era, surgery is performed with minimally invasive techniques in order to reduce the trauma inflicted on patients, hasten their recovery and hence reduce the hospital stay. T-tube insertion seems to negate these benefits and we believe that primary closure can be as safe as closure with T-tube drainage.

METHODOLOGY

This is a retrospective analysis of patients who underwent primary closure of the CBD after successful laparoscopic choledochotomy for ductal stones between January 2000 and December 2003. A concurrent control group of patients who underwent T-tube drainage was used for comparison.

RESULTS

Of the 64 patients that underwent laparoscopic exploration of the CBD, 24 (37%) underwent transcystic duct approach and 40 (63%) underwent choledochotomy. There were three open conversions (5%). Stone clearance was achieved in all patients with successful laparoscopic choledochotomy (100%). Of the 38 successful laparoscopic choledochotomies, 12 had primary closure of the CBD and 26 had closure with T-tube drainage. There was no mortality in both groups. One patient in the primary closure group suffered from paralytic ileus and small subhepatic collection which was treated conservatively. The median operative time (90 vs. 120 minutes, p=0.002) and postoperative stay (5 vs. 8.5 days, p=0.003) were shorter in the primary closure group when compared with the T-tube group.

CONCLUSIONS

Primary closure of the CBD is feasible and as safe as T-tube insertion after laparoscopic choledochotomy for stone disease.

摘要

背景/目的：证明胆总管结石患者行腹腔镜胆总管切开术后一期缝合胆总管（CBD）的安全性和可行性。传统上，胆总管切开取石术后用T管引流来闭合胆总管。然而，T管置入并非没有并发症，患者在拔除前需携带数周。在腹腔镜时代，采用微创技术进行手术以减少对患者的创伤，加速康复并缩短住院时间。T管置入似乎会抵消这些益处，我们认为一期缝合与T管引流闭合一样安全。

方法

这是一项对2000年1月至2003年12月间因胆管结石成功行腹腔镜胆总管切开术后行胆总管一期缝合患者的回顾性分析。同时设立接受T管引流的对照组进行比较。

结果

在64例行腹腔镜胆总管探查的患者中，24例（37%）采用经胆囊管途径，40例（63%）行胆总管切开术。有3例中转开腹（5%）。所有成功行腹腔镜胆总管切开术的患者结石均清除（100%）。在38例成功的腹腔镜胆总管切开术中，12例行胆总管一期缝合，26例行T管引流闭合。两组均无死亡病例。一期缝合组1例患者发生麻痹性肠梗阻和小的肝下积液，经保守治疗。与T管组相比，一期缝合组的中位手术时间（90分钟对120分钟，p = 0.002）和术后住院时间（5天对8.5天，p = 0.003）更短。