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.	郑伟, 张云. 老年胆总管结石患者腹腔镜胆总管探查术后一期缝合与T管引流疗效比较. 世界华人消化杂志, 2017, 25(1): 91-95.
3.	梁阔, 刘东斌, 刘家峰, 等. 腹腔镜胆总管探查一期缝合在老年胆总管结石病人中的应用. 首都医科大学学报, 2017, 38(1): 78-81.
4.	丁轶人, 江涌, 赵伟, 等. 腹腔镜联合纤维胆道镜治疗老年胆总管结石108例临床体会. 腹腔镜外科杂志, 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.	李红军, 赵静, 段仁全, 等. 腹腔镜胆总管探查术后胆总管一期缝合与T管引流的疗效观察. 中国普外基础与临床杂志, 2016, 23(7): 873-875.
7.	马大喜, 李可为, 程明荣, 等. LC+LCBDE胆总管一期缝合与T管引流治疗胆囊胆总管结石的随机对照研究. 海南医学, 2018, 29(7): 930-934.
8.	巴合提•卡力甫, 戈小虎, 孟塬, 等. 腹腔镜胆总管探查术后一期缝合与T管引流的meta分析. 中国普外基础与临床杂志, 2017, 24(4): 489-495.
9.	马先仕, 王雄彪, 肖绪鹏, 等. 快速康复外科在腹腔镜下胆总管结石手术的临床应用. 中华实验外科杂志, 2015, 32(2): 425-426.
10.	刘立川, 张峻, 刘伟. 腹腔镜胆总管探查术治疗老年胆总管结石. 中国普通外科杂志, 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.	温顺前, 谢学弈, 巫青, 等. 腹腔镜下胆总管探查取石术后胆总管一期缝合的疗效分析. 中国普通外科杂志, 2018, 27(2): 163-168.
14.	刘威, 沈根海, 高泉根, 等. 腹腔镜胆总管一期缝合术与T管引流术治疗肝外胆管结石的疗效比较. 腹腔镜外科杂志, 2016, 21(7): 543-546.
15.	杨永林, 张鹏, 郭永恒. 腹腔镜胆总管探查取石术后胆管一期缝合对比T管引流安全性和有效性的meta分析. 甘肃科技, 2017, 33(12): 123-126.
16.	梁阔, 刘东斌, 刘家峰, 等. 老年患者腹腔镜胆总管探查一期缝合与T管引流的临床疗效分析. 腹腔镜外科杂志, 2017, 22(10): 774-777.
17.	肖宏, 孙科, 田刚, 等. 腹腔镜下倒刺缝线与可吸收缝线缝合胆总管切口的效果比较研究. 中国内镜杂志, 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.	王国军, 马国峰, 沈华强. 腹腔镜胆总管探查Ⅰ期缝合对T管引流术后胆道压力及效果分析. 浙江创伤外科, 2017, 22(1): 5-8.
20.	索运生, 张明哲, 尹思能, 等. 腹腔镜胆总管探查、一期缝合和T管引流后胆道压力变化的比较. 中国微创外科杂志, 2006, 6(1): 21-23.
21.	陈伟, 罗一帆, 吕品, 等. 胆总管一期缝合及鼻胆管引流治疗胆总管结石的疗效与安全性. 中国普通外科杂志, 2018, 27(2): 175-181.
22.	刘洪波. 预置鼻胆管引流胆总管切开取石一期缝合胆总管对胆总管结石的治疗价值. 中国现代药物应用, 2016, 10(20): 21-22.
23.	苏树炎. J型管胆总管内引流一期缝合胆总管切开术的可行性研究. 数理医药学杂志, 2016, 29(2): 191-192.
24.	吴金柱, 蔡卫华, 吴建军, 等. 老年人结石性胆总管梗阻腹腔镜胆道一期缝合自行脱落J型管置入治疗的体会. 中华普外科手术学杂志(电子版), 2017, 11(6): 516-518.
25.	尹飞飞, 孙世波, 李志钰, 等. 双镜联合胆总管探查胆道一期缝合术后胆汁漏的防治. 中华肝胆外科杂志, 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.	朱鸣雷, 刘晓红. 老年患者围手术期管理. 中国实用内科杂志, 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. 郑伟, 张云. 老年胆总管结石患者腹腔镜胆总管探查术后一期缝合与T管引流疗效比较. 世界华人消化杂志, 2017, 25(1): 91-95.
3. 梁阔, 刘东斌, 刘家峰, 等. 腹腔镜胆总管探查一期缝合在老年胆总管结石病人中的应用. 首都医科大学学报, 2017, 38(1): 78-81.
4. 丁轶人, 江涌, 赵伟, 等. 腹腔镜联合纤维胆道镜治疗老年胆总管结石108例临床体会. 腹腔镜外科杂志, 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. 李红军, 赵静, 段仁全, 等. 腹腔镜胆总管探查术后胆总管一期缝合与T管引流的疗效观察. 中国普外基础与临床杂志, 2016, 23(7): 873-875.
7. 马大喜, 李可为, 程明荣, 等. LC+LCBDE胆总管一期缝合与T管引流治疗胆囊胆总管结石的随机对照研究. 海南医学, 2018, 29(7): 930-934.
8. 巴合提•卡力甫, 戈小虎, 孟塬, 等. 腹腔镜胆总管探查术后一期缝合与T管引流的meta分析. 中国普外基础与临床杂志, 2017, 24(4): 489-495.
9. 马先仕, 王雄彪, 肖绪鹏, 等. 快速康复外科在腹腔镜下胆总管结石手术的临床应用. 中华实验外科杂志, 2015, 32(2): 425-426.
10. 刘立川, 张峻, 刘伟. 腹腔镜胆总管探查术治疗老年胆总管结石. 中国普通外科杂志, 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. 温顺前, 谢学弈, 巫青, 等. 腹腔镜下胆总管探查取石术后胆总管一期缝合的疗效分析. 中国普通外科杂志, 2018, 27(2): 163-168.
14. 刘威, 沈根海, 高泉根, 等. 腹腔镜胆总管一期缝合术与T管引流术治疗肝外胆管结石的疗效比较. 腹腔镜外科杂志, 2016, 21(7): 543-546.
15. 杨永林, 张鹏, 郭永恒. 腹腔镜胆总管探查取石术后胆管一期缝合对比T管引流安全性和有效性的meta分析. 甘肃科技, 2017, 33(12): 123-126.
16. 梁阔, 刘东斌, 刘家峰, 等. 老年患者腹腔镜胆总管探查一期缝合与T管引流的临床疗效分析. 腹腔镜外科杂志, 2017, 22(10): 774-777.
17. 肖宏, 孙科, 田刚, 等. 腹腔镜下倒刺缝线与可吸收缝线缝合胆总管切口的效果比较研究. 中国内镜杂志, 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. 王国军, 马国峰, 沈华强. 腹腔镜胆总管探查Ⅰ期缝合对T管引流术后胆道压力及效果分析. 浙江创伤外科, 2017, 22(1): 5-8.
20. 索运生, 张明哲, 尹思能, 等. 腹腔镜胆总管探查、一期缝合和T管引流后胆道压力变化的比较. 中国微创外科杂志, 2006, 6(1): 21-23.
21. 陈伟, 罗一帆, 吕品, 等. 胆总管一期缝合及鼻胆管引流治疗胆总管结石的疗效与安全性. 中国普通外科杂志, 2018, 27(2): 175-181.
22. 刘洪波. 预置鼻胆管引流胆总管切开取石一期缝合胆总管对胆总管结石的治疗价值. 中国现代药物应用, 2016, 10(20): 21-22.
23. 苏树炎. J型管胆总管内引流一期缝合胆总管切开术的可行性研究. 数理医药学杂志, 2016, 29(2): 191-192.
24. 吴金柱, 蔡卫华, 吴建军, 等. 老年人结石性胆总管梗阻腹腔镜胆道一期缝合自行脱落J型管置入治疗的体会. 中华普外科手术学杂志(电子版), 2017, 11(6): 516-518.
25. 尹飞飞, 孙世波, 李志钰, 等. 双镜联合胆总管探查胆道一期缝合术后胆汁漏的防治. 中华肝胆外科杂志, 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. 朱鸣雷, 刘晓红. 老年患者围手术期管理. 中国实用内科杂志, 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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