Department of Laparoscopic Treatment Center, The First People's Hospital of Changzhou, 3rd Hospital Affiliated to Soochow University, 185 Juqian Street, Changzhou 213003, Jiangsu, China.
World J Surg. 2012 Jan;36(1):164-70. doi: 10.1007/s00268-011-1346-6.
Laparoscopic common bile duct exploration (LCBDE) has become one of the main options for treating choledocholithiasis associated with cholelithiasis. Our objective was to assess the short-term outcomes of patients undergoing laparoscopic primary closure of the common bile duct (CBD) compared with laparoscopic choledochotomy plus T-tube drainage.
We retrospectively studied 137 patients undergoing primary closure following LCBDE (group A) compared with 102 cases with laparoscopic choledochotomy plus T-tube drainage (group B) between January 2007 and January 2010. Intraoperative cholangiography (IOC) and choledochoscopy were performed in all patients.
Three patients in group A (2.2%) were converted to open surgery and two (2.0%) in group B because of serious adherence. According to routine IOC, unexpected CBD stones were found in 16 cases (6.8%). The duration of the operation in group A was shorter than in group B (92.4 ± 15.2 vs. 125.7± 32.6 min, P < 0.05), as was length of postoperative stay (3.1± 2.4 vs. 5.7± 4.3 days, P < 0.05). Postoperative bile leakage occurred in six patients (4.5%) in group A and four cases (4.0%) in group B; all of the patients recovered after simple drainage without reoperation. Bile peritonitis was seen in one case after T-tube removal. The median follow-up was 26 months. There were no recurrences.
Laparoscopic primary closure of the CBD is safe and successful for the management of CBD stones. Application of IOC and choledochoscopy to ensure clearance of the CBD and careful suturing are essential for primary closure.
腹腔镜胆总管探查术（LCBDE）已成为治疗伴有胆石症的胆总管结石的主要方法之一。我们的目的是评估腹腔镜胆总管（CBD）一期缝合与腹腔镜胆总管切开加 T 管引流治疗胆总管结石的短期疗效。
我们回顾性研究了 2007 年 1 月至 2010 年 1 月期间 137 例行 LCBDE 后一期缝合的患者（A 组）和 102 例行腹腔镜胆总管切开加 T 管引流的患者（B 组）。所有患者均行术中胆道造影（IOC）和胆道镜检查。
A 组有 3 例（2.2%）患者中转开腹，B 组有 2 例（2.0%）患者因严重粘连而中转开腹。根据常规 IOC，16 例（6.8%）患者发现意外 CBD 结石。A 组的手术时间短于 B 组（92.4±15.2 比 125.7±32.6min，P<0.05），术后住院时间也短于 B 组（3.1±2.4 比 5.7±4.3d，P<0.05）。A 组有 6 例（4.5%）患者术后发生胆漏，B 组有 4 例（4.0%）患者术后发生胆漏；所有患者均经简单引流而无需再次手术痊愈。1 例 T 管拔除后发生胆汁性腹膜炎。中位随访 26 个月，无复发。
腹腔镜胆总管一期缝合治疗胆总管结石是安全有效的。应用 IOC 和胆道镜检查确保 CBD 通畅和仔细缝合是一期缝合的关键。
