Khaled Yazan S, Malde Deep J, de Souza Ciaran, Kalia Amun, Ammori Basil J
Department of Hepato-Pancreato-Biliary Surgery, North Manchester General Hospital, Delaunays Road, Crumpsall, Manchester,, M8 5RB, UK,
Surg Endosc. 2013 Nov;27(11):4164-70. doi: 10.1007/s00464-013-3015-3. Epub 2013 May 30.
The common bile duct traditionally is managed with T-tube drainage after choledochotomy and removal of common bile duct (CBD) stones, but this approach carries an associated tube-related morbidity rate, including bile leak, of 10.5-20 %. This study examined the safety and effectiveness of laparoscopic CBD exploration (LCBDE) followed by primary duct closure.
This is a retrospective analysis of 120 consecutive patients (81 female) who underwent LCBDE between October 2002 and October 2012. The duct primarily was closed in all patients. The results are given as median (range).
Trans-CBD exploration was performed in 120 patients and all cases were successfully completed laparoscopically. The maximum diameter of the CBD was 9.4 (3-30) mm and the number of CBD stones detected was 3 (0-20). The biliary tree was clear at the end of exploration in 116 patients (96.7 %). The operating time was 122 (70-360) min. The mortality rate, morbidity rate, postoperative bile leak rate, rate of retained CBD stones after the primary procedure, and CBD stricture rate at a follow-up of 39.2 (2-82) months were 0, 8.3, 2.5, 3.3, and 0.8 %, respectively. The postoperative hospital stay was 2.1 (1-29) days.
Primary duct closure following LCBDE is safe, can be employed routinely as an alternative to T-tube insertion, and has a short hospital stay and low morbidity rate.
传统上，胆总管切开取石术后采用T管引流来处理胆总管，但这种方法存在与T管相关的发病率，包括胆漏，发生率为10.5%-20%。本研究探讨了腹腔镜胆总管探查术（LCBDE）后一期胆管缝合的安全性和有效性。
这是一项对2002年10月至2012年10月期间连续120例接受LCBDE患者（81例女性）的回顾性分析。所有患者均进行胆管一期缝合。结果以中位数（范围）表示。
120例患者接受了经胆总管探查，所有病例均成功完成腹腔镜手术。胆总管最大直径为9.4（3-30）mm，检测到的胆总管结石数量为3（0-20）枚。116例患者（96.7%）探查结束时胆管树清晰。手术时间为122（70-360）分钟。在39.2（2-82）个月的随访中，死亡率、发病率、术后胆漏率、一期手术后胆总管残留结石率和胆总管狭窄率分别为0、8.3%、2.5%、3.3%和0.8%。术后住院时间为2.1（1-29）天。
LCBDE后一期胆管缝合是安全的，可常规用作T管置入的替代方法，住院时间短且发病率低。
