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 , 刘其雨 ³ , 陈刚 ³ , 李立 ³ ,  夏红天 ¹

1. ;
2. ;
3. ;

Corresponding author：

夏红天, Email: Xiahongtian115@sina.com

Keywords：

一期缝合; T管引流; 腹腔镜; 胆总管探查; 肝外胆管结石

DOI：

10.7507/1007-9424.20140369

Video：

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目的比较腹腔镜下胆总管探查一期缝合与T管引流治疗肝外胆管结石的效果，总结腹腔镜下胆总管探查一期缝合的临床经验。方法回顾性分析2010年1月至2012年12月期间于中国人民解放军总医院施行腹腔镜下胆总管探查取石的121例肝外胆管结石患者的临床资料，比较一期缝合组（n=63）与T管引流组（n=58）的手术时间、术中出血量、术后住院时间、胆瘘发生率、胆总管狭窄发生率及结石复发率。结果 2组患者均顺利完成腹腔镜手术。术后一期缝合组发生胆瘘3例，T管引流组发生1例。2组患者的术中出血量和胆瘘发生率比较差异均无统计学意义（P＞0.05），但T管引流组的手术时间和术后住院时间均较长（P=0.000）。术后所有患者获访4～36个月，平均12个月。随访期间均无复发、胆总管狭窄及死亡发生。结论腹腔镜下胆总管探查一期缝合治疗肝外胆管结石安全而有效，并且避免了术后T管的护理，有望成为处理肝外胆管结石的主流术式。

Citation： 耿春蕊, 刘其雨, 陈刚, 李立, 夏红天. 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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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.
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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. Strömberg 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. 陈盛, 郑江华, 区应亮, 等.两种微创方式治疗胆囊结石合并胆总管结石的临床疗效比较[J].中国普外基础与临床杂志, 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. 李建军.腹腔镜胆总管探查术后一期缝合与置T管引流的临床对照研究[J].中华普通外科杂志, 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 Española, 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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