腹腔镜胆总管探查术加一期缝合治疗老年胆总管结石安全可行。
Laparoscopic common bile duct exploration with primary closure is safe for management of choledocholithiasis in elderly patients.
机构信息
Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510000, China; Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510000, China.
Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510000, China.
出版信息
Hepatobiliary Pancreat Dis Int. 2019 Dec;18(6):557-561. doi: 10.1016/j.hbpd.2019.07.005. Epub 2019 Jul 25.
BACKGROUND
Laparoscopic common bile duct exploration (LCBDE) is one of the minimally invasive options for choledocholithiasis. Primary closure of the common bile duct (CBD) upon completion of laparoscopic choledochotomy is safe in selected patients. The present study aimed to evaluate the feasibility and safety of primary closure of CBD after LCBDE in patients aged 70 years or older.
METHODS
A total of 116 patients (51 males and 65 females) who suffered from choledocholithiasis and underwent primary closure of the CBD (without T-tube drainage) after LCBDE from January 2003 to December 2017 were recruited. They were classified into two groups according to age: group A (≥70 years, n = 56), and group B (<70 years, n = 60). The preoperative characteristics, intraoperative details, and postoperative outcomes of the two groups were evaluated.
RESULTS
The mean operative time was 172.02 min for group A and 169.92 min for group B (P = 0.853). The mean hospital stay was 7.40 days for group A and 5.38 days for group B (P < 0.001). Bile leakage occurred in two patients in group A and one in group B (3.57% vs 1.67%, P = 0.952). There were no significant differences in the rates of postoperative complications and mortality between the two groups. At median follow-up time of 60 months, stone recurrence was detected in one patient in group A and two in group B (1.79% vs 3.33%, P = 1.000). Stenosis of CBD was not observed in group A and slight stenosis in one patient in group B (0 vs 1.67%, P = 1.000).
CONCLUSION
Primary closure of the CBD upon completion of laparoscopic choledochotomy is safe and feasible in elderly patients ≥70 years old.
背景
腹腔镜胆总管探查术（LCBDE）是治疗胆总管结石的微创选择之一。在选定的患者中，腹腔镜胆总管切开术后行胆总管（CBD）一期缝合是安全的。本研究旨在评估在 70 岁或以上的患者中行 LCBDE 后行 CBD 一期缝合的可行性和安全性。
方法
2003 年 1 月至 2017 年 12 月，我们共招募了 116 例（51 例男性和 65 例女性）因胆总管结石而行 LCBDE 后行 CBD 一期缝合（无 T 管引流）的患者。根据年龄将其分为两组：A 组（≥70 岁，n=56）和 B 组（<70 岁，n=60）。评估两组患者的术前特征、术中细节和术后结果。
结果
A 组的平均手术时间为 172.02 分钟，B 组为 169.92 分钟（P=0.853）。A 组的平均住院时间为 7.40 天，B 组为 5.38 天（P<0.001）。A 组有 2 例患者发生胆漏，B 组有 1 例患者发生胆漏（3.57%比 1.67%，P=0.952）。两组术后并发症和死亡率无显著差异。中位随访 60 个月时，A 组有 1 例患者复发结石，B 组有 2 例患者复发结石（1.79%比 3.33%，P=1.000）。A 组未发现 CBD 狭窄，B 组有 1 例患者 CBD 轻度狭窄（0 比 1.67%，P=1.000）。
结论
在 70 岁或以上的老年患者中，腹腔镜胆总管切开术后行胆总管一期缝合是安全可行的。
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