Department of Hepatobiliary-Pancreatic-Splenic Surgery, Chengdu First People's Hospital (Chengdu Integrated TCM & Western Medicine Hospital), High Tech District, No. 18 Wanxiang North Road, Chengdu, 610044, Sichuan, People's Republic of China.
Sci Rep. 2023 Dec 18;13(1):22473. doi: 10.1038/s41598-023-49173-3.
Common bile duct (CBD) exploration and T-tube drainage are the main surgical methods for the removal of bile duct stones (BDSs), which can now be completed by laparoscopy. However, the feasibility and safety of primary closure of the CBD (PCCBD) in laparoscopic CBD exploration (LCBDE) without biliary drainage are still uncertain. From January 1, 2021, to June 30, 2022, patients who were diagnosed with BDSs and underwent LCBDE and primary closure of the CBD without biliary drainage in our hospital were included. The clinical and prognostic data of the patients were retrospectively analyzed to determine the feasibility and safety of PCCBD in LCBDE without biliary drainage. Forty-nine patients successfully underwent PCCBD in LCBDE without biliary drainage. The operation time was 158.8 ± 50.3 (90-315,150) minutes, the bile duct suture time was 17.6 ± 4.46 (10-26, 18) minutes, the intraoperative blood loss volume was 70.4 ± 52.6 (5-200, 80) ml, the hospitalization cost was 28,141.2 ± 7011.3 (15,005.45-52,959.34, 26,815.14) CNY Yuan, the hospitalization time was 13.22 ± 5.16 (8-32, 12) days, and the postoperative hospitalization time was 7.31 ± 1.94 (3-15, 7) days. There were 3 cases of postoperative bile leakage (3/49, 6.12%), all of them healed by nonsurgical treatment. During the follow-up of 17.2 ± 11.01 (10-26, 17) months, no residual BDSs, biliary stricture or other complications classified as Clavien-Dindo grade I or higher occurred. For some selected patients who meet certain criteria, PCCBD in LCBDE without biliary drainage is feasible and safe and is more conducive to the rapid postoperative recovery of patients.
胆总管（CBD）探查和 T 管引流是胆管结石（BDS）的主要手术方法，现在可以通过腹腔镜完成。然而，在腹腔镜胆总管探查（LCBDE）中不进行胆汁引流而进行 CBD 一期缝合（PCCBD）的可行性和安全性仍不确定。从 2021 年 1 月 1 日至 2022 年 6 月 30 日，我院收治了诊断为 BDS 并接受 LCBDE 和 CBD 无胆汁引流一期缝合的患者。回顾性分析患者的临床和预后资料，以确定 LCBDE 中不进行胆汁引流时 PCCBD 的可行性和安全性。49 例患者成功地在 LCBDE 中进行了 CBD 无胆汁引流一期缝合。手术时间为 158.8±50.3（90-315，150）分钟，胆管缝合时间为 17.6±4.46（10-26，18）分钟，术中出血量为 70.4±52.6（5-200，80）ml，住院费用为 28141.2±7011.3（15005.45-52959.34，26815.14）元，住院时间为 13.22±5.16（8-32，12）天，术后住院时间为 7.31±1.94（3-15，7）天。术后有 3 例发生胆漏（3/49，6.12%），均经非手术治疗治愈。在 17.2±11.01（10-26，17）个月的随访中，无残留 BDS、胆管狭窄或其他分类为 Clavien-Dindo Ⅰ级或更高级别的并发症发生。对于一些符合某些标准的选定患者，LCBDE 中不进行胆汁引流的 PCCBD 是可行和安全的，更有利于患者术后的快速恢复。
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