Effect of Primary Closure Versus T-Tube Drainage after Laparoscopic Common Bile Duct Exploration_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 耿春蕊 ^1,2 , 劉其雨 ³ , 陳剛 ³ , 李立 ³ ,  夏紅天 ¹

1. ;
2. ;
3. ;

Corresponding?author：

夏紅天, Email: Xiahongtian115@sina.com

Keywords：

一期縫合; T管引流; 腹腔鏡; 膽總管探查; 肝外膽管結石

DOI：

10.7507/1007-9424.20140369

Video：

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目的比較腹腔鏡下膽總管探查一期縫合與T管引流治療肝外膽管結石的效果，總結腹腔鏡下膽總管探查一期縫合的臨床經驗。方法回顧性分析2010年1月至2012年12月期間于中國人民解放軍總醫院施行腹腔鏡下膽總管探查取石的121例肝外膽管結石患者的臨床資料，比較一期縫合組（n=63）與T管引流組（n=58）的手術時間、術中出血量、術后住院時間、膽瘺發生率、膽總管狹窄發生率及結石復發率。結果 2組患者均順利完成腹腔鏡手術。術后一期縫合組發生膽瘺3例，T管引流組發生1例。2組患者的術中出血量和膽瘺發生率比較差異均無統計學意義（P＞0.05），但T管引流組的手術時間和術后住院時間均較長（P=0.000）。術后所有患者獲訪4～36個月，平均12個月。隨訪期間均無復發、膽總管狹窄及死亡發生。結論腹腔鏡下膽總管探查一期縫合治療肝外膽管結石安全而有效，并且避免了術后T管的護理，有望成為處理肝外膽管結石的主流術式。

Citation： 耿春蕊, 劉其雨, 陳剛, 李立, 夏紅天. Effect of Primary Closure Versus T-Tube Drainage after Laparoscopic Common Bile Duct Exploration. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(12): 1561-1563. doi: 10.7507/1007-9424.20140369 Copy

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11.	Cai H, Sun D, Sun Y, et al.Primary closure following laparoscopic common bile duct exploration combined with intraoperative cholangiography and choledochoscopy[J].World J Surg, 2012, 36(1):164-170.
12.	Mangla V, Chander J, Vindal A, et al.A randomized trial comp-aring the use of endobiliary stent and T-tube for biliary decompression after laparoscopic common bile duct exploration[J].Surg Laparosc Endosc Percutan Tech, 2012, 22(4):345-348.
13.	El-Geidie AA.Is the use of T-tube necessary after laparoscopic choledochotomy?[J].J Gastrointest Surg, 2010, 14(5):844-848.
14.	Sankarankutty AK, Mente ED, Cardoso NM, et al.T-tube or no T-tube for bile duct anastomosis in orthotopic liver transplantation[J].Hepatobiliary Surg Nutr, 2013, 2(3):171-173.
15.	Zhang HW, Chen YJ, Wu CH, et al.Laparoscopic common bile duct exploration with primary closure for management of choledocholithiasis:a retrospective analysis and comparison with conventional T-tube drainage[J].Am Surg, 2014, 80(2):178-181.
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18.	Wang C, Wang Q, Sun D, et al.Immunogenic alteration in laparoscopic common bile duct exploration[J].J Surg Res, 2014, 187(1):302-309.

1. Ingraham AM, Cohen ME, Ko CY, et al.A current profile and assessment of north American cholecystectomy:results from the American college of surgeons national surgical quality improvement program[J].J Am Coll Surg, 2010, 211(2):176-186.
2. Str?mberg C, Nilsson M.Nationwide study of the treatment of common bile duct stones in Sweden between 1965 and 2009[J].Br J Surg, 2011, 98(12):1766-1774.
3. Van Dijk AH, Lamberts M, Van Laarhoven CJ, et al.Laparoscopy in cholecysto-choledocholithiasis[J].Best Pract Res Clin Gastroenterol, 2014, 28(1):195-209.
4. Joshi MR, Sharma SK.Laparoscopic primary repair of common bile duct:does the suture size matter[J].J Nepal Health Res Counc, 2011, 9(1):10-13.
5. 陳盛, 鄭江華, 區應亮, 等.兩種微創方式治療膽囊結石合并膽總管結石的臨床療效比較[J].中國普外基礎與臨床雜志, 2012, 19(11):1213-1217.
6. Grubnik VV, Tkachenko AI, Ilyashenko VV, et al.Laparoscopic common bile duct exploration versus open surgery:comparative prospective randomized trial[J].Surg Endosc, 2012, 26(8):2165-2171.
7. 李建軍.腹腔鏡膽總管探查術后一期縫合與置T管引流的臨床對照研究[J].中華普通外科雜志, 2013, 28(11):836-838.
8. Dong ZT, Wu GZ, Luo KL, et al.Primary closure after laparoscopic common bile duct exploration versus T-tube[J].J Surg Res, 2014, 189(2):249-254.
9. Abellán Morcillo I, Qurashi K, Abrisqueta Carrión J, et al.Lapa-roscopic common bile duct exploration.Lessons learned after 200 cases[J].Cirugía Espa?ola, 2014, 92(5):341-347.
10. Wu X, Yang Y, Dong P, et al.Primary closure versus T-tube drainage in laparoscopic common bile duct exploration:a meta-analysis of randomized clinical trials[J].Langenbecks Arch Surg, 2012, 397(6):909-916.
11. Cai H, Sun D, Sun Y, et al.Primary closure following laparoscopic common bile duct exploration combined with intraoperative cholangiography and choledochoscopy[J].World J Surg, 2012, 36(1):164-170.
12. Mangla V, Chander J, Vindal A, et al.A randomized trial comp-aring the use of endobiliary stent and T-tube for biliary decompression after laparoscopic common bile duct exploration[J].Surg Laparosc Endosc Percutan Tech, 2012, 22(4):345-348.
13. El-Geidie AA.Is the use of T-tube necessary after laparoscopic choledochotomy?[J].J Gastrointest Surg, 2010, 14(5):844-848.
14. Sankarankutty AK, Mente ED, Cardoso NM, et al.T-tube or no T-tube for bile duct anastomosis in orthotopic liver transplantation[J].Hepatobiliary Surg Nutr, 2013, 2(3):171-173.
15. Zhang HW, Chen YJ, Wu CH, et al.Laparoscopic common bile duct exploration with primary closure for management of choledocholithiasis:a retrospective analysis and comparison with conventional T-tube drainage[J].Am Surg, 2014, 80(2):178-181.
16. Martínez-Baena D, Parra-Membríves P, Díaz-Gómez D, et al.Laparoscopic common bile duct exploration and antegrade biliary stenting:leaving behind the Kehr tube[J].Rev Esp Enferm Dig, 2013, 105(3):125-129.
17. Yin Z, Xu K, Sun J, et al.Is the end of the T-tube drainage era in laparoscopic choledochotomy for common bile duct stones is coming? A systematic review and meta-analysis[J].Ann Surg, 2013, 257(1):54-66.
18. Wang C, Wang Q, Sun D, et al.Immunogenic alteration in laparoscopic common bile duct exploration[J].J Surg Res, 2014, 187(1):302-309.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of Primary Closure Versus T-Tube Drainage after Laparoscopic Common Bile Duct Exploration

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