Dong Hanzhang, Liu Xi, Luo Mingjian, Ke Shaobiao, Zhan Jiulin, Li Zhiwei
Department of Hepatobiliary and Pancreatic Surgery, Kanghua Hospital, Dongguan, Guangdong 523080, P.R. China.
Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China.
Med Int (Lond). 2021 Sep 2;1(4):14. doi: 10.3892/mi.2021.14. eCollection 2021 Sep-Oct.
Choledocholithiasis is a common disease of the biliary system. The traditional surgical method for this is to remove the gallbladder, open the common bile duct, remove the stones and place a T-tube in the common bile duct for drainage. Common bile duct exploration usually requires a T-tube. Without a T-tube, there is a risk of bile leakage due to pressure in the bile duct. After the T-tube is placed, patients experience some form of discomfort and inconveniences with daily life, and there is also a risk of accidental detachment, as well as a risk of bile leakage when the T-tube is removed. In severe cases, patients may need to be hospitalized again. With advancements being made in surgical instruments and technology, laparoscopic common bile duct exploration has been widely used. Due to the carbon dioxide pneumoperitoneum, laparoscopic common bile duct exploration requires a long period of time for T-tube sinus formation compared with open surgery. Therefore, the extubation time needs to be prolonged in laparoscopic common bile duct exploration. The use of an internal drainage tube may be used in order to avoid the aforementioned disadvantages. Since 2012, the authors have performed laparoscopic common bile duct exploration with the placement of an internal drainage tube for the treatment of common bile duct stones, and have completed >160 surgeries. The present study provides a summary of the data of these 160 cases. The 160 patients underwent laparoscopic cholecystectomy. Following the removal of the stones, an internal drainage tube was placed, and the common bile duct incision was primary sutured. All patients were discharged, and there were no complications, such as biliary leakage, biliary bleeding and biliary stricture. On the whole, the present study demonstrates that where possible, the placement of an internal drainage tube in laparoscopic common bile duct exploration is safe and reliable, and may be used to avoid the risk of bile leakage without a T-tube, any inconveniences for patients, and the risk of bile leakage following the removal of the T-tube.
胆总管结石是胆道系统的一种常见疾病。其传统手术方法是切除胆囊，切开胆总管，取出结石，并在胆总管内放置T管进行引流。胆总管探查通常需要放置T管。若无T管，胆管内压力会导致胆汁漏出。放置T管后，患者会在日常生活中经历某种形式的不适和不便，还存在意外脱落的风险，以及拔除T管时胆汁漏出的风险。严重时，患者可能需要再次住院。随着手术器械和技术的进步，腹腔镜胆总管探查术已被广泛应用。由于二氧化碳气腹，与开放手术相比，腹腔镜胆总管探查术形成T管窦道所需时间较长。因此，腹腔镜胆总管探查术的拔管时间需要延长。为避免上述缺点，可使用内引流管。自2012年以来，作者采用放置内引流管的腹腔镜胆总管探查术治疗胆总管结石，已完成160余例手术。本研究总结了这160例病例的数据。这160例患者均接受了腹腔镜胆囊切除术。取出结石后，放置内引流管，胆总管切口进行一期缝合。所有患者均已出院，未出现胆漏、胆道出血和胆管狭窄等并发症。总体而言，本研究表明，在腹腔镜胆总管探查术中，尽可能放置内引流管是安全可靠的，可避免无T管时的胆汁漏出风险、给患者带来的任何不便以及拔除T管后的胆汁漏出风险。
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