正常直径胆总管行腹腔镜下胆总管探查一期缝合的安全性及可行性

目的探讨正常直径胆总管行腹腔镜下胆总管探查一期缝合的安全性与可行性。方法回顾性分析盛京医院2014年1月1日至2019年11月30日收治的行腹腔镜下胆总管探查一期缝合的120例患者资料,其中男性44例,女性76例,平均年龄57.2(22.0~88.0)岁。根据胆总管直径大小将患者分为扩张组(>8 mm)和正常组(≤8 mm)。比较两组患者手术时间、术中出血量、术后住院时间、术后腹腔引流管拔除时间与术后并发症的发生情况。结果扩张组纳入76例患者,其中男性25例,女性51例,中位年龄62.5岁;正常组纳入44例,其中男性19例,女性25例,中位年龄57.5岁。两组患者性别、年龄、白蛋白水平、总胆红素等基线资料差异无统计学意义(P>0.05)。两组患者手术时间正常组106.0(87.3,146.3)min比扩张组112.0(90.5,134.5)min]、术中出血量正常组20(10,30)ml比扩张组20(10,20)ml]、术后住院时间正常组7.0(5.3,9.0)d比扩张组7.0(5.0,7.0)d]、术后腹腔引流管拔除时间正常组6(4,7)d比扩张组5(4,6)d]差异均无统计学意义(P>0.05)。两组患者术后胆漏、胆道狭窄、结石复发等并发症的发生率差异无统计学意义(P>0.05)。结论在正常直径(≤8 mm)胆总管的患者中行腹腔镜下胆总管探查联合一期缝合术安全有效。

Safety and efficacy of primary closure in patients with normal diameters of common bile duct after laparoscopic common bile duct exploration

Objective To study the safety and efficacy of primary closure of non-dilaed common bile ducts(CBD)after laparoscopic common bile duct exploration.Methods A retrospective study was conducted on the clinical data of 120 patients who underwent primary closure of CBD after laparoscopic CBD exploration(LCBDE)at the Shengjing Hospital of China Medical University from April 1,2014 to November 30,2019.There were 44 males and 76 females,aged 22.0 to 88.0 years,(average age of 57.2 years).These patients were divided into the dilated CBD group(diameter of CBD>8 mm)and the normal CBD group(diameter of CBD≤8 mm).The following factors,including operating time,intraoperative bleeding,postoperative hospitalization stay,abdominal drainage tube indwelling time and postoperative complications were compared.Results The dilated CBD group consisted of 76 patients,with 25 males and 51 females,and a median age of 62.5 years.The normal CBD group consisted of 44 patients,with 19 males and 25 females,and a median age of 57.5 years.There were no significant differences in gender,age,albumin level,total bilirubin and other baseline data between groups(P>0.05).The operation times of the two groups were:the normal CBD group106.6(87.3,146.3]min vs the dilated CBD group112.0(90.5,134.5)]min;intraoperative blood lossthe normal CBD group 20(10,30)ml vs dilated CBD group 20(10,20)ml];postoperative hospital staythe normal CBD group 7.0(5.3,9.0)d vs the dilated CBD group 7.0(5.0,7.0)d];and postoperative abdominal drainage tube removal timethe normal CBD group 6(4,7)d vs the dilated CBD group 5(4,6)d].The differences were all not significant(P>0.05).There was also no significant difference in the incidences of postoperative complications(including bile leakage,biliary stricture,and stone recurrence between groups,all P>0.05).Conclusion In patients with a normal diameter(≤8 mm)common bile duct,it was safe and efficacious to perform primary closure after laparoscopic common bile duct exploration.