Clinical observation of primary suture following laparoscopic common bile duct exploration in patients aged over 70 years old with common bile duct stones_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

JIANG Songlin ,  YE Hui

Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

YE Hui, Email: yehuimd@163.com

Keywords：

elderly patient; laparoscopic common bile duct exploration; primary suture; T tube drainage

DOI：

10.7507/1007-9424.201805009

Video：

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Objective To explore clinical effect of primary suture following laparoscopic common bile duct exploration (LCBDE) in treatment of patients aged over 70 years old with common bile duct (CBD) stones. Methods The clinical data of 62 patients aged over 70 years old with CBD stones underwent the LCBDE from January 2013 to December 2016 were retrospectively analyzed. Among them, 30 patients underwent the T tube drainage (T tube drainage group) and 32 patients underwent the primary suture (primary suture group) following the LCBDE. The intraoperative and postoperative statuses of these two groups were compared. Results There were no significant differences in the gender, age, body mass index, preoperative comorbidities and ASA classification, number and maximum diameter of CBD stone, and diameter of CBD between the two groups (P>0.05). There were no significant differences in the operative time, hospitalization cost, rates of total postoperative complications and readmission between the two groups (P>0.05). Compared with the T tube drainage group, the amount of intraoperative bleeding was less (P<0.05) and the postoperative hospital stay was shorter (P<0.05) in the primary suture group. Conclusion Primary suture is safe and feasible following LCBDE for patients aged over 70 years old with CBD stones in case of strict indications and proficiency intraoperation and it is more beneficial to recovery of patient.

Citation： JIANG Songlin, YE Hui. Clinical observation of primary suture following laparoscopic common bile duct exploration in patients aged over 70 years old with common bile duct stones. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(10): 1213-1217. doi: 10.7507/1007-9424.201805009 Copy

1.	Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg, 2004, 188(3): 205-211.
2.	鄭偉, 張云. 老年膽總管結石患者腹腔鏡膽總管探查術后一期縫合與T管引流療效比較. 世界華人消化雜志, 2017, 25(1): 91-95.
3.	梁闊, 劉東斌, 劉家峰, 等. 腹腔鏡膽總管探查一期縫合在老年膽總管結石病人中的應用. 首都醫科大學學報, 2017, 38(1): 78-81.
4.	丁軼人, 江涌, 趙偉, 等. 腹腔鏡聯合纖維膽道鏡治療老年膽總管結石108例臨床體會. 腹腔鏡外科雜志, 2014, 19(7): 547-550.
5.	Oliveira-Cunha M, Dennison AR, Garcea G. Late complications after endoscopic sphincterotomy. Surg Laparosc Endosc Percutan Tech, 2016, 26(1): 1-5.
6.	李紅軍, 趙靜, 段仁全, 等. 腹腔鏡膽總管探查術后膽總管一期縫合與T管引流的療效觀察. 中國普外基礎與臨床雜志, 2016, 23(7): 873-875.
7.	馬大喜, 李可為, 程明榮, 等. LC+LCBDE膽總管一期縫合與T管引流治療膽囊膽總管結石的隨機對照研究. 海南醫學, 2018, 29(7): 930-934.
8.	巴合提?卡力甫, 戈小虎, 孟塬, 等. 腹腔鏡膽總管探查術后一期縫合與T管引流的meta分析. 中國普外基礎與臨床雜志, 2017, 24(4): 489-495.
9.	馬先仕, 王雄彪, 肖緒鵬, 等. 快速康復外科在腹腔鏡下膽總管結石手術的臨床應用. 中華實驗外科雜志, 2015, 32(2): 425-426.
10.	劉立川, 張峻, 劉偉. 腹腔鏡膽總管探查術治療老年膽總管結石. 中國普通外科雜志, 2014, 23(8): 1154-1156.
11.	Dong ZT, Wu GZ, Luo KL, et al. Primary closure after laparoscopic common bile duct exploration versus T-tube. J Surg Res, 2014, 189(2): 249-254.
12.	Mangla V, Chander J, Vindal A, et al. A randomized trial comparing the use of endobiliary stent and T-tube for biliary decompression after laparoscopic common bile duct exploration. Surg Laparosc Endosc Percutan Tech, 2012, 22(4): 345-348.
13.	溫順前, 謝學弈, 巫青, 等. 腹腔鏡下膽總管探查取石術后膽總管一期縫合的療效分析. 中國普通外科雜志, 2018, 27(2): 163-168.
14.	劉威, 沈根海, 高泉根, 等. 腹腔鏡膽總管一期縫合術與T管引流術治療肝外膽管結石的療效比較. 腹腔鏡外科雜志, 2016, 21(7): 543-546.
15.	楊永林, 張鵬, 郭永恒. 腹腔鏡膽總管探查取石術后膽管一期縫合對比T管引流安全性和有效性的meta分析. 甘肅科技, 2017, 33(12): 123-126.
16.	梁闊, 劉東斌, 劉家峰, 等. 老年患者腹腔鏡膽總管探查一期縫合與T管引流的臨床療效分析. 腹腔鏡外科雜志, 2017, 22(10): 774-777.
17.	肖宏, 孫科, 田剛, 等. 腹腔鏡下倒刺縫線與可吸收縫線縫合膽總管切口的效果比較研究. 中國內鏡雜志, 2016, 22(6): 40-43.
18.	Muzaffar I, Zula P, Yimit Y, et al. Randomized comparison of postoperative short-term and mid-term complications between T-tube and primary closure after CBD exploration. J Coll Physicians Surg Pak, 2014, 24(11): 810-814.
19.	王國軍, 馬國峰, 沈華強. 腹腔鏡膽總管探查Ⅰ期縫合對T管引流術后膽道壓力及效果分析. 浙江創傷外科, 2017, 22(1): 5-8.
20.	索運生, 張明哲, 尹思能, 等. 腹腔鏡膽總管探查、一期縫合和T管引流后膽道壓力變化的比較. 中國微創外科雜志, 2006, 6(1): 21-23.
21.	陳偉, 羅一帆, 呂品, 等. 膽總管一期縫合及鼻膽管引流治療膽總管結石的療效與安全性. 中國普通外科雜志, 2018, 27(2): 175-181.
22.	劉洪波. 預置鼻膽管引流膽總管切開取石一期縫合膽總管對膽總管結石的治療價值. 中國現代藥物應用, 2016, 10(20): 21-22.
23.	蘇樹炎. J型管膽總管內引流一期縫合膽總管切開術的可行性研究. 數理醫藥學雜志, 2016, 29(2): 191-192.
24.	吳金柱, 蔡衛華, 吳建軍, 等. 老年人結石性膽總管梗阻腹腔鏡膽道一期縫合自行脫落J型管置入治療的體會. 中華普外科手術學雜志(電子版), 2017, 11(6): 516-518.
25.	尹飛飛, 孫世波, 李志鈺, 等. 雙鏡聯合膽總管探查膽道一期縫合術后膽汁漏的防治. 中華肝膽外科雜志, 2015, 21(2): 113-116.
26.	Rizzuto A, Serra R, Mignogna C, et al. Single incision laparoscopic cholecystectomy in geriatric patients. Int J Surg, 2016, 35: 83-87.
27.	朱鳴雷, 劉曉紅. 老年患者圍手術期管理. 中國實用內科雜志, 2016, 36(3): 227-230.

1. Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg, 2004, 188(3): 205-211.
2. 鄭偉, 張云. 老年膽總管結石患者腹腔鏡膽總管探查術后一期縫合與T管引流療效比較. 世界華人消化雜志, 2017, 25(1): 91-95.
3. 梁闊, 劉東斌, 劉家峰, 等. 腹腔鏡膽總管探查一期縫合在老年膽總管結石病人中的應用. 首都醫科大學學報, 2017, 38(1): 78-81.
4. 丁軼人, 江涌, 趙偉, 等. 腹腔鏡聯合纖維膽道鏡治療老年膽總管結石108例臨床體會. 腹腔鏡外科雜志, 2014, 19(7): 547-550.
5. Oliveira-Cunha M, Dennison AR, Garcea G. Late complications after endoscopic sphincterotomy. Surg Laparosc Endosc Percutan Tech, 2016, 26(1): 1-5.
6. 李紅軍, 趙靜, 段仁全, 等. 腹腔鏡膽總管探查術后膽總管一期縫合與T管引流的療效觀察. 中國普外基礎與臨床雜志, 2016, 23(7): 873-875.
7. 馬大喜, 李可為, 程明榮, 等. LC+LCBDE膽總管一期縫合與T管引流治療膽囊膽總管結石的隨機對照研究. 海南醫學, 2018, 29(7): 930-934.
8. 巴合提?卡力甫, 戈小虎, 孟塬, 等. 腹腔鏡膽總管探查術后一期縫合與T管引流的meta分析. 中國普外基礎與臨床雜志, 2017, 24(4): 489-495.
9. 馬先仕, 王雄彪, 肖緒鵬, 等. 快速康復外科在腹腔鏡下膽總管結石手術的臨床應用. 中華實驗外科雜志, 2015, 32(2): 425-426.
10. 劉立川, 張峻, 劉偉. 腹腔鏡膽總管探查術治療老年膽總管結石. 中國普通外科雜志, 2014, 23(8): 1154-1156.
11. Dong ZT, Wu GZ, Luo KL, et al. Primary closure after laparoscopic common bile duct exploration versus T-tube. J Surg Res, 2014, 189(2): 249-254.
12. Mangla V, Chander J, Vindal A, et al. A randomized trial comparing the use of endobiliary stent and T-tube for biliary decompression after laparoscopic common bile duct exploration. Surg Laparosc Endosc Percutan Tech, 2012, 22(4): 345-348.
13. 溫順前, 謝學弈, 巫青, 等. 腹腔鏡下膽總管探查取石術后膽總管一期縫合的療效分析. 中國普通外科雜志, 2018, 27(2): 163-168.
14. 劉威, 沈根海, 高泉根, 等. 腹腔鏡膽總管一期縫合術與T管引流術治療肝外膽管結石的療效比較. 腹腔鏡外科雜志, 2016, 21(7): 543-546.
15. 楊永林, 張鵬, 郭永恒. 腹腔鏡膽總管探查取石術后膽管一期縫合對比T管引流安全性和有效性的meta分析. 甘肅科技, 2017, 33(12): 123-126.
16. 梁闊, 劉東斌, 劉家峰, 等. 老年患者腹腔鏡膽總管探查一期縫合與T管引流的臨床療效分析. 腹腔鏡外科雜志, 2017, 22(10): 774-777.
17. 肖宏, 孫科, 田剛, 等. 腹腔鏡下倒刺縫線與可吸收縫線縫合膽總管切口的效果比較研究. 中國內鏡雜志, 2016, 22(6): 40-43.
18. Muzaffar I, Zula P, Yimit Y, et al. Randomized comparison of postoperative short-term and mid-term complications between T-tube and primary closure after CBD exploration. J Coll Physicians Surg Pak, 2014, 24(11): 810-814.
19. 王國軍, 馬國峰, 沈華強. 腹腔鏡膽總管探查Ⅰ期縫合對T管引流術后膽道壓力及效果分析. 浙江創傷外科, 2017, 22(1): 5-8.
20. 索運生, 張明哲, 尹思能, 等. 腹腔鏡膽總管探查、一期縫合和T管引流后膽道壓力變化的比較. 中國微創外科雜志, 2006, 6(1): 21-23.
21. 陳偉, 羅一帆, 呂品, 等. 膽總管一期縫合及鼻膽管引流治療膽總管結石的療效與安全性. 中國普通外科雜志, 2018, 27(2): 175-181.
22. 劉洪波. 預置鼻膽管引流膽總管切開取石一期縫合膽總管對膽總管結石的治療價值. 中國現代藥物應用, 2016, 10(20): 21-22.
23. 蘇樹炎. J型管膽總管內引流一期縫合膽總管切開術的可行性研究. 數理醫藥學雜志, 2016, 29(2): 191-192.
24. 吳金柱, 蔡衛華, 吳建軍, 等. 老年人結石性膽總管梗阻腹腔鏡膽道一期縫合自行脫落J型管置入治療的體會. 中華普外科手術學雜志(電子版), 2017, 11(6): 516-518.
25. 尹飛飛, 孫世波, 李志鈺, 等. 雙鏡聯合膽總管探查膽道一期縫合術后膽汁漏的防治. 中華肝膽外科雜志, 2015, 21(2): 113-116.
26. Rizzuto A, Serra R, Mignogna C, et al. Single incision laparoscopic cholecystectomy in geriatric patients. Int J Surg, 2016, 35: 83-87.
27. 朱鳴雷, 劉曉紅. 老年患者圍手術期管理. 中國實用內科雜志, 2016, 36(3): 227-230.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical observation of primary suture following laparoscopic common bile duct exploration in patients aged over 70 years old with common bile duct stones

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