非重症急性胆管炎患者行腹腔镜胆总管探查一期缝合与T管引流的比较

doi:10.3969/j.issn.1006-6233.2022.10.017

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Abstract Objective: To investigate the safety and effectiveness of primary suture (PC) after laparoscopic common bile duct exploration (LCBDE) in patients with non-severe acute cholangitis (AC).Methods: The clinical and follow-up data of 50 patients with non-severe acute cholangitis who underwent LCBDE from March 2018 to March 2020 in the Department of Hepatobiliary Surgery, Hebei Provincial People's Hospital affiliated to North China University of Science and Technology were selected, and the clinical indexes of 25 cases with primary suture of common bile duct (PC groups) and 25 cases with T-tube drainage (T-tube group) were compared. Results: Of the 50 patients, 49 cases were successfully operated, and 1 case was converted to laparotomy. There was no significant difference in gender, age, body mass index (BMI), American Association of Anesthesiologists (ASA) grade, acute cholangitis (AC) grade, acute cholecystitis cases, common bile duct diameter, preoperative complications, clinical symptoms and signs between the two groups (P>0.05). There was no significant difference in serum total bilirubin (TB), direct bilirubin (DBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and glutamyl transpeptidase (GGT) between the two groups before operation (P>0.05). Compared with T-tube group, PC group had shorter operation time, less intraoperative blood loss, shorter abdominal drainage time and shorter postoperative hospital stay, and the differences were statistically significant (t/z/P =6.144/<0.001,2.143/0.032,2.504/0.016,2.561/0.014). There were no residual stones, injury of adjacent organs during operation and death in hospital in both groups. The total incidence of postoperative complications such as biliary fistula, abdominal hemorrhage, electrolyte disturbance, venous thrombosis of lower limbs, pleural effusion, nausea and vomiting in PC group was not significantly different from that in T-tube group (χ²=2.228, P=0.136). During the follow-up, no biliary stricture occurred in the two groups, and 2 patients in T-tube group had stone recurrence. Conclusion: PC after LCBDE in patients with non-severe AC choledocholithiasis has shown better clinical outcomes than the T-tube group in terms of operative time, intraoperative bleeding, abdominal drainage time and postoperative hospital stay, making it a safe and feasible treatment option.

Key words： Common bile duct stones Laparoscopic common bile duct exploration Primary closure Acute cholangitis

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2022.10.017 OR http://www.hbyxzzs.cn/EN/Y2022/V28/I10/1667

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