Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Biliary-Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Biliary-Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
Asian J Surg. 2023 Aug;46(8):3046-3051. doi: 10.1016/j.asjsur.2022.09.132. Epub 2022 Oct 22.
Although laparoscopic common bile duct exploration (LCBDE) is considered a safe and effective method for the removal of bile duct stones, selecting primary duct closure (PDC) or T-tube drainage (TTD) following choledochotomy remains controversial. This study aims to explore the clinical effects of PDC and TTD after LCBDE.
We retrospectively analyzed clinical data of 348 patients with choledocholithiasis treated with LCBDE from January 2016 to October 2020. All patients were divided into PDC (225 cases) and TTD (123 cases) groups. Propensity score matching (PSM) was performed. We compared operative parameters and outcomes.
After matching (n = 116/group), no significant difference was observed between the two groups (P > 0.05) regarding intra-abdominal infection, incision infection, bile leakage, and retained stones. In terms of operation time, intraoperative blood loss, postoperative hospital stay, postoperative exhaust time, postoperative antibiotic use time, and postoperative abdominal drainage time, PDC group was obviously superior to TTD group (P < 0.05).
Primary closure following LCBDE is considered a safe and effective alternative to T-tube drainage.
尽管腹腔镜胆总管探查术（LCBDE）被认为是一种安全有效的胆管结石清除方法，但胆总管切开后选择行胆总管一期缝合（PDC）还是 T 管引流（TTD）仍存在争议。本研究旨在探讨 LCBDE 后行 PDC 和 TTD 的临床效果。
我们回顾性分析了 2016 年 1 月至 2020 年 10 月期间 348 例接受 LCBDE 治疗的胆总管结石患者的临床资料。所有患者均分为 PDC（225 例）和 TTD（123 例）组。采用倾向性评分匹配（PSM）。比较两组患者的手术参数和结局。
匹配后（n=116/组），两组患者在腹腔感染、切口感染、胆漏和残余结石方面无显著差异（P>0.05）。在手术时间、术中出血量、术后住院时间、术后排气时间、术后抗生素使用时间和术后腹腔引流时间方面，PDC 组明显优于 TTD 组（P<0.05）。
LCBDE 后行胆总管一期缝合被认为是 T 管引流的一种安全有效的替代方法。
