胆总管(CBD)探查术和T管引流是清除胆总管结石(BDSs)的主要手术方法,现在可以通过腹腔镜检查完成。然而,在腹腔镜CBD探查术(LCBDE)中初次闭合CBD(PCCBD)而不进行胆道引流的可行性和安全性仍不确定.从2021年1月1日至2022年6月30日,纳入了在我院诊断为BDS并接受LCBDE和CBD初次闭合而无胆道引流的患者。回顾性分析患者的临床和预后资料,以确定不进行胆道引流的LCBDE中PCCBD的可行性和安全性。49例患者在LCBDE中成功接受了PCCBD,没有胆道引流。手术时间158.8±50.3(90-315,150)分钟,胆管缝合时间为17.6±4.46(10-26,18)分钟,术中出血量为70.4±52.6(5-200,80)ml,住院费用为28,141.2±7011.3(15,005.45-52,959.34,26,815.14)元,住院时间为13.22±5.16(8-32,12)天,术后住院时间为7.31±1.94(3~15、7)天。术后胆漏3例(3/49,6.12%),他们都通过非手术治疗治愈了。随访17.2±11.01(10-26,17)个月,没有残留的BDS,发生胆道狭窄或其他分类为Clavien-DindoI级或更高的并发症。对于一些符合某些标准的患者,PCCBD在LCBDE中不进行胆道引流是可行和安全的,更有利于患者术后的快速恢复。
Common bile duct (CBD) exploration and T-tube drainage are the main surgical methods for the removal of bile duct stones (BDSs), which can now be completed by laparoscopy. However, the feasibility and safety of primary closure of the CBD (PCCBD) in laparoscopic CBD exploration (LCBDE) without biliary drainage are still uncertain. From January 1, 2021, to June 30, 2022, patients who were diagnosed with BDSs and underwent LCBDE and primary closure of the CBD without biliary drainage in our hospital were included. The clinical and prognostic data of the patients were retrospectively analyzed to determine the feasibility and safety of PCCBD in LCBDE without biliary drainage. Forty-nine patients successfully underwent PCCBD in LCBDE without biliary drainage. The operation time was 158.8 ± 50.3 (90-315,150) minutes, the bile duct suture time was 17.6 ± 4.46 (10-26, 18) minutes, the intraoperative blood loss volume was 70.4 ± 52.6 (5-200, 80) ml, the hospitalization cost was 28,141.2 ± 7011.3 (15,005.45-52,959.34, 26,815.14) CNY Yuan, the hospitalization time was 13.22 ± 5.16 (8-32, 12) days, and the postoperative hospitalization time was 7.31 ± 1.94 (3-15, 7) days. There were 3 cases of postoperative bile leakage (3/49, 6.12%), all of them healed by nonsurgical treatment. During the follow-up of 17.2 ± 11.01 (10-26, 17) months, no residual BDSs, biliary stricture or other complications classified as Clavien-Dindo grade I or higher occurred. For some selected patients who meet certain criteria, PCCBD in LCBDE without biliary drainage is feasible and safe and is more conducive to the rapid postoperative recovery of patients.