腹腔镜胆囊切除术前行经皮胆囊引流管保留对手术结果的影响：CSGO-HBP-017事后分析

Effect of Preserving the Percutaneous Gallbladder Drainage Tube Before Laparoscopic Cholecystectomy on Surgical Outcome: Post Hoc Analysis of the CSGO-HBP-017.

作者信息

Tomimaru Yoshito, Fukuchi Nariaki, Yokoyama Shigekazu, Mori Takuji, Tanemura Masahiro, Sakai Kenji, Takeda Yutaka, Tsujie Masanori, Yamada Terumasa, Miyamoto Atsushi, Hashimoto Yasuji, Hatano Hisanori, Shimizu Junzo, Sugimoto Keishi, Kashiwazaki Masaki, Matsumoto Kenichi, Kobayashi Shogo, Doki Yuichiro, Eguchi Hidetoshi

机构信息

Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka E-2, Suita, Osaka, 565-0871, Japan.

Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan.

出版信息

J Gastrointest Surg. 2022 Jun;26(6):1224-1232. doi: 10.1007/s11605-022-05291-3. Epub 2022 Mar 21.

DOI:10.1007/s11605-022-05291-3

PMID:35314945

Abstract

BACKGROUND

When percutaneous transhepatic gallbladder drainage (PTGBD) is followed by laparoscopic cholecystectomy (LC), there is no consensus regarding whether the drainage tube should be preserved or removed before LC. We hypothesized that the surgical results of LC might differ between cases with PTGBD tube preservation versus removal. Here, we investigated how drainage tube preservation or removal affected the surgical outcome of LC.

METHODS

Using data from our previous multicenter study, we compared LC outcomes after PTGBD between patients with PTGBD tube preservation versus removal. This study included 208 patients who underwent LC over 12 days after PTGBD. In 83 cases, the PTGBD tube was preserved until LC, and in 125 cases, the tube was removed before LC. The results were verified by propensity score matching with 50 patients in each group.

RESULTS

Cases with tube preservation versus removal exhibited significantly longer surgery duration (174 ± 105 min vs 145 ± 61 min, P = .0118) and postoperative hospital stay (14 ± 16 days vs 7 ± 7 days, P < .0001), a significantly higher postoperative complication rate (13.2% vs 3.2%, P = .0061), and a marginally higher incidence of open conversion (12.0% vs 4.8%, P = .0547). Propensity score matching verified the inferior surgical outcomes in cases with tube preservation.

CONCLUSIONS

These results imply that when LC is performed > 12 days after PTGBD, the surgical outcome may be inferior when the drainage tube is preserved rather than removed before LC.

摘要

背景

在经皮经肝胆囊引流术（PTGBD）后行腹腔镜胆囊切除术（LC）时，对于在LC前引流管应保留还是拔除尚无共识。我们推测，PTGBD管保留与拔除的病例中LC的手术结果可能不同。在此，我们研究了引流管的保留或拔除如何影响LC的手术结局。

方法

利用我们之前多中心研究的数据，我们比较了PTGBD管保留与拔除的患者PTGBD后的LC结局。本研究纳入了208例在PTGBD后12天以上接受LC的患者。83例中，PTGBD管保留至LC，125例中，引流管在LC前拔除。通过倾向评分匹配每组50例患者对结果进行验证。

结果

保留引流管与拔除引流管的病例相比，手术时间显著更长（174±105分钟 vs 145±61分钟，P = 0.0118），术后住院时间显著更长（14±16天 vs 7±7天，P < 0.0001），术后并发症发生率显著更高（13.2% vs 3.2%，P = 0.0061），开放转换率略高（12.0% vs 4.8%，P = 0.0547）。倾向评分匹配验证了保留引流管的病例手术结局较差。