胆囊切除术联合腹腔镜下胆总管探查术后胆总管一期缝合与T管引流的疗效比较

目的:探讨腹腔镜下胆囊切除术(LC)联合腹腔镜下胆总管探查术(LCBDE)后胆总管一期缝合与T管引流治疗胆囊结石合并胆总管结石的疗效差异。方法:回顾分析2013年4月—2018年4月218例行LC+LCBDE患者的临床资料,其中90例一期缝合,128例T管引流。对比两组患者的相关临床指标,分析患者术后并发症发生的影响因素。结果:两组患者的术前一般资料、术中出血量、术后肛门首次通气时间、术后电解质紊乱发生率、术后结石残余率差异无统计学意义(均P0.05)。一期缝合组手术时间、术后住院时间、住院费用明显少于T管引流组,腹腔引流时间长于T管引流组(均P0.05);一期缝合组术后胆汁漏发生率明显高于T管引流组(8.89%vs.2.34%,P=0.030),术后结石复发率明显低于T管引流组(1.11%vs.7.03%,P=0.040)。统计分析显示,一期缝合是术后胆汁漏的独立危险因素,而T管引流是术后结石复发的独立危险因素(均P0.05)。结论:LC+LCBDE术后一期缝合可有效减少术后胆总管结石复发,T管引流可有效减少术后胆汁漏发生。两者尚不能完全互相替代,需把握严格的手术指征。

Efficacy comparison between primary closure and T-tube drainage following laparoscopic cholecystectomy with common bile duct exploration

Objective: To investigate the difference in efficacy between primary closure and T-tube drainage following laparoscopic cholecystectomy (LC) with laparoscopic common bile duct exploration (LCBDE) in treatment of gallbladder stones combined with common bile duct stones.  Methods: The clinical data of 218 patients undergoing LC+LCBDE from April 2013 to April 2018 were retrospectively analyzed. Of the patients, 90 cases underwent primary closure of the common bile duct and 128 cases were subjected to T-tube drainage. The main clinical variables between the two groups of patients were compared, and the factors for the occurrence of complications were analyzed. Results: There were no significant differences in preoperative general data, intraoperative blood loss, time to first postoperative anal gas passage, incidence of postoperative electrolyte disturbance and residual stone rate between the two groups (all P>0.05). In primary closure group, the operative time, length of postoperative hospital stay and hospitalization cost were reduced, but the time for postoperative abdominal drainage was prolonged significantly compared with T-tube drainage group (all P<0.05). In primary closure group versus T-tube drainage group, the incidence of postoperative bile leakage was significantly higher (8.89% vs. 2.34%, P=0.030), while the incidence of postoperative stone recurrence rate was significantly lower (1.11% vs. 7.03%, P=0.040). Statistical analysis showed that primary closure was an independent risk factor for the occurrence of postoperative bile leakage, and T-tube drainage was an independent risk factor for the occurrence of stone recurrence (both P<0.05). Conclusion: In LC+LCBDE, primary closure can effectively reduce the recurrence of postoperative common bile duct stones, while T-tube drainage can effectively reduce the incidence of postoperative bile leakage. These two methods cannot entirely be replaced by each other, and the indications should be rigorously followed.