Safety and efficacy of primary duct closure after laparoscopic common bile duct exploration: analysis of 128 cases

doi:10.3877/cma.j.issn.2095-3232.2024.04.018

Abstract

Abstract:

Objective

To evaluate the safety and efficacy of primary duct closure after laparoscopic common bile duct exploration (LCBDE).

Methods

Clinical data of 128 patients with common bile duct stones admitted to Zhujiang Hospital of Southern Medical University from February 2020 to February 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 84 patients were male and 44 female, aged from 21 to 89 years with the median of 59 years. All patients were treated with LCBDE. According to different closure methods of common bile duct, all patients were divided into primary duct closure group (PDC group, n=60) and T-tube drainage group (TTD group, n=68). Perioperative liver function and incidence of complications were observed between two groups. Liver function between two groups was compared by independent sample t test or nonparametric test. The incidence of complications was compared by Chi-square test or Fisher's exact test.

Results

In the PDC group, the average AST and ALT levels at postoperative 3 dwere (25.6±1.5) and (52.5±5.4) U/L, significantly lower than (38.8±4.6) and (97.1±15.5) U/L in the TTD group (t=-2.752, -2.197; P<0.05). In the PDC group, the operation time, time to first flatus, length of postoperative hospital stay and hospitalization expense were respectively (134±5) min, (36.6±2.2) h, (4.47±0.14) d and (4.70±0.15)×10⁴ Yuan, significantly less than (163±7) min, (53.6±2.2) h, (6.15±0.35) dand (5.78±0.17)×10⁴ Yuan in the TTD group (t=-3.029, -5.307, -3.573, -5.171; P<0.05). The overall incidence of complications in two groups was 29%(20/68) and 15%(9/60) respectively, and the difference was not statistically significant (χ²=3.778, P>0.05). In the TTD group, 6 patients had residual stones, whereas no case had residual stones in the PDC group, and the difference was statistically significant (P=0.018). No death or postoperative biliary stricture was observed in two groups.

Conclusions

Compared with TTD, PDC in LCBDE can shorten operation time, accelerate postoperative recovery, decrease treatment cycle, reduce medical expenses and increase one-time stone clearance rate without increasing the overall incidence of complications, which is a safe and efficient minimally invasive procedure.

Key words: Common bile duct stones, Laparoscopic common bile duct exploration, Primary duct closure, T-tube drainage, Residual stone, Enhanced recovery after surgery

Jianan Feng, Lei Cai, Guolin He, Shunjun Fu, Cheng Zhang, Zhoubin Feng, Yaohong Wen, Hongkun Tan, Mingxin Pan. Safety and efficacy of primary duct closure after laparoscopic common bile duct exploration: analysis of 128 cases[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(04): 543-550.

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References 29

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组别	例数（例）	性别（例）		年龄（岁，±s）	BMI（kg/m²）	结石数（例）		胆总管直径（mm，±s）	ASA分级评分（分，±s）	心脏疾病（例）	轻、中度胆管炎（例）	2型糖尿病（例）	高血压病（例）	肺部疾病（例）
组别	例数（例）	男	女	年龄（岁，±s）	BMI（kg/m²）	单发	多发	胆总管直径（mm，±s）	ASA分级评分（分，±s）	心脏疾病（例）	轻、中度胆管炎（例）	2型糖尿病（例）	高血压病（例）	肺部疾病（例）
PDC组	60	36	24	58.5±2.1	22.2±0.3	42	18	12.7±0.6	2.23±0.06	5	33	11	14	4
TTD组	68	48	20	60.2±2.1	22.7±0.4	51	17	12.8±0.5	2.21±0.05	5	46	6	18	3
统计值		χ²=1.584		t=-0.573	t=-0.832	χ²=0.401		t=-0.114	t=0.151	-	χ²=2.158	χ²=2.503	χ²=0.167	χ²=0.029
P值		0.208		0.568	0.407	0.527		0.909	0.880	1.000	0.142	0.114	0.683	0.865

组别	例数（例）	性别（例）		年龄（岁，±s）	BMI（kg/m²）	结石数（例）		胆总管直径（mm，±s）	ASA分级评分（分，±s）	心脏疾病（例）	轻、中度胆管炎（例）	2型糖尿病（例）	高血压病（例）	肺部疾病（例）
组别	例数（例）	男	女	年龄（岁，±s）	BMI（kg/m²）	单发	多发	胆总管直径（mm，±s）	ASA分级评分（分，±s）	心脏疾病（例）	轻、中度胆管炎（例）	2型糖尿病（例）	高血压病（例）	肺部疾病（例）
PDC组	60	36	24	58.5±2.1	22.2±0.3	42	18	12.7±0.6	2.23±0.06	5	33	11	14	4
TTD组	68	48	20	60.2±2.1	22.7±0.4	51	17	12.8±0.5	2.21±0.05	5	46	6	18	3
统计值		χ²=1.584		t=-0.573	t=-0.832	χ²=0.401		t=-0.114	t=0.151	-	χ²=2.158	χ²=2.503	χ²=0.167	χ²=0.029
P值		0.208		0.568	0.407	0.527		0.909	0.880	1.000	0.142	0.114	0.683	0.865

组别	例数	入院术前肝功能指标
组别	例数	TB（μmol/L）	DB（μmol/L）	AST（U/L）	ALT（U/L）	GGT（U/L）	ALP（U/L）	ALB（g/L）
PDC组	60	48.5±7.0	34.2±5.5	122.9±23.6	181.7±32.4	345±35	209±18	37.5±0.8
TTD组	68	58.6±6.0	43.4±5.0	128.0±20.1	197.7±26.7	455±56	197±20	38.3±0.6
t值		-1.230	-1.177	-0.057	-0.466	-0.356	1.053	-0.803
P值		0.219	0.239	0.954	0.641	0.722	0.292	0.423
组别	例数	术后3 d肝功能指标
组别	例数	TB（μmol/L）	DB（μmol/L）	AST（U/L）	ALT（U/L）	GGT（U/L）	ALP（U/L）	ALB（g/L）
PDC组	60	24.2±2.2	15.3±1.7	25.6±1.5	52.5±5.4	159±13	129±9	33.6±0.5
TTD组	68	31.0±3.9	20.9±3.2	38.8±4.6	97.1±15.5	208±27	128±9	34.6±0.5
t值		-0.998	-1.274	-2.752	-2.197	-0.145	0.386	-1.471
P值		0.318	0.203	0.006	0.028	0.885	0.700	0.144

组别	例数	入院术前肝功能指标
组别	例数	TB（μmol/L）	DB（μmol/L）	AST（U/L）	ALT（U/L）	GGT（U/L）	ALP（U/L）	ALB（g/L）
PDC组	60	48.5±7.0	34.2±5.5	122.9±23.6	181.7±32.4	345±35	209±18	37.5±0.8
TTD组	68	58.6±6.0	43.4±5.0	128.0±20.1	197.7±26.7	455±56	197±20	38.3±0.6
t值		-1.230	-1.177	-0.057	-0.466	-0.356	1.053	-0.803
P值		0.219	0.239	0.954	0.641	0.722	0.292	0.423
组别	例数	术后3 d肝功能指标
组别	例数	TB（μmol/L）	DB（μmol/L）	AST（U/L）	ALT（U/L）	GGT（U/L）	ALP（U/L）	ALB（g/L）
PDC组	60	24.2±2.2	15.3±1.7	25.6±1.5	52.5±5.4	159±13	129±9	33.6±0.5
TTD组	68	31.0±3.9	20.9±3.2	38.8±4.6	97.1±15.5	208±27	128±9	34.6±0.5
t值		-0.998	-1.274	-2.752	-2.197	-0.145	0.386	-1.471
P值		0.318	0.203	0.006	0.028	0.885	0.700	0.144

组别	例数	手术时间（min）	术中出血量（ml）	腹腔引流管留置时间（h）	术后肛门排气时间（h）	术后住院时间（d）	住院费用（万元）
PDC组	60	134±5	51±7	92±5	36.6±2.2	4.47±0.14	4.70±0.15
TTD组	68	163±7	62±6	99±7	53.6±2.2	6.15±0.35	5.78±0.17
t值		-3.029	-1.662	-0.012	-5.307	-3.573	-5.171
P值		0.002	0.096	0.990	<0.001	<0.001	<0.001

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