老年胆总管结石患者行腹腔镜胆总管探查一期缝合是安全可行的。
Laparoscopic common bile duct exploration with primary closure could be safely performed among elderly patients with choledocholithiasis.
机构信息
Department of Geriatric Medicine, Shenzhen Traditional Chinese Medicine Hospital, Fuhua Road 1, Futian District, Shenzhen, 518033, Guangdong, China.
Department of Radiology, Shenzhen People's Hospital, Dongmen Road 1017, Luohu District, Shenzhen, 518020, Guangdong, China.
出版信息
BMC Geriatr. 2023 Aug 11;23(1):486. doi: 10.1186/s12877-023-04149-w.
BACKGROUND
For patients with choledocholithiasis, laparoscopic common bile duct exploration (LCBDE) is preferred over open surgery. Whether primary closure of the common bile duct (CBD) should be performed upon completion of choledochotomy remains unclear, and the corresponding indications for primary closure of the common bile duct have yet to be fully identified. This study was performed to evaluate the safety and feasibility of primary closure of CBD among elderly patients (≥ 70 years) after LCBDE.
METHODS
Patients with choledocholithiasis who had undergone LCBDE with primary closure of the CBD between July 2014 and December 2020 were retrospectively reviewed. Included patients were assigned into two groups (Group A: ≥70 years and Group B: <70 years) according to age. Group A was compared with Group B in terms of preoperative characteristics, intraoperative results and postoperative outcomes.
RESULTS
The mean operative time for Group A was 176.59 min (± 68.950), while the mean operative time for Group B was 167.64 min (± 69.635) (P = 0.324). The mean hospital stay after surgery for Group A was 8.43 days (± 4.440), while that for Group B was 8.30 days (± 5.203) (P = 0.849). Three patients in Group A experienced bile leakage, while bile leakage occurred in 10 patients in Group B (3.8% vs. 4.5%, P = 0.781). Group A was not significantly different from Group B in terms of postoperative complications and 30-day mortality except pneumonia (P = 0.016), acute cardiovascular event (P = 0.005) and ICU observation (P = 0.037). After a median follow-up time of 60 months, 2 patients in Group A and 2 patients in Group B experienced stone recurrence (2.5% vs. 0.9%, P = 0.612). One patient in Group A experienced stenosis of the CBD, while stenosis of the CBD occurred in 5 patients in Group B (1.3% vs. 2.2%, P = 0.937).
CONCLUSIONS
Primary closure of CBD upon completion of LCBDE could be safely performed among patients ≥ 70 years.
背景
对于胆总管结石患者，腹腔镜胆总管探查术（LCBDE）优于开放手术。胆总管切开术后是否应行胆总管一期缝合尚不清楚，胆总管一期缝合的适应证也尚未完全明确。本研究旨在评估 LCBDE 后老年患者（≥70 岁）行胆总管一期缝合的安全性和可行性。
方法
回顾性分析 2014 年 7 月至 2020 年 12 月期间行 LCBDE 并一期缝合胆总管的胆总管结石患者。根据年龄将患者分为两组（A 组：≥70 岁；B 组：<70 岁）。比较两组患者的术前特征、术中结果和术后结局。
结果
A 组的平均手术时间为 176.59 分钟（±68.950），B 组的平均手术时间为 167.64 分钟（±69.635）（P=0.324）。A 组术后平均住院时间为 8.43 天（±4.440），B 组为 8.30 天（±5.203）（P=0.849）。A 组有 3 例患者发生胆漏，B 组有 10 例患者发生胆漏（3.8%比 4.5%，P=0.781）。除肺炎（P=0.016）、急性心血管事件（P=0.005）和 ICU 观察（P=0.037）外，A 组与 B 组在术后并发症和 30 天死亡率方面无显著差异。中位随访 60 个月后，A 组有 2 例患者和 B 组有 2 例患者发生结石复发（2.5%比 0.9%，P=0.612）。A 组有 1 例患者发生胆总管狭窄，B 组有 5 例患者发生胆总管狭窄（1.3%比 2.2%，P=0.937）。
结论
LCBDE 后行胆总管一期缝合在≥70 岁的患者中是安全可行的。
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