Safety and efficacy of laparoscopic transcystic common bile duct exploration combined with primary suture in treatment of choledocholithiasis

doi:10.3877/cma.j.issn.2095-3232.2021.02.011

Abstract

Abstract:

Objective

To evaluate the safety and efficacy of laparoscopic transcystic common bile duct exploration (LTCBDE) combined with primary suture in the treatment of choledocholithiasis.

Methods

Clinical data of 70 patients with choledocholithiasis admitted to Binhaiwan Central Hospital of Dongguan from January 2016 to December 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 33 patients were male and 37 female, aged from 37 to 72 years, with a median age of 53 years. All patients were divided into LTCBDE group (n=36) and choledochotomy + T-tube drainage group (T-tube group, n=34). In LTCBDE group, LTCBDE combined with primary suture was performed. In T-tube group, choledochotomy combined with T-tube drainage was performed. Perioperative conditions such as operation time, length of postoperative hospital stay, visual analogue scale (VAS) score and Gastrointestinal Quality of Life Index (GIQLI) score between two groups were statistically compared with t test.

Results

Operations in all patients were completed successfully. In LTCBDE group, the average operation time and length of postoperative hospital stay were (100±11) min and (5.1±0.9) d, significantly shorter than (121±13) min and (7.0±1.3) din T-tube group (t=-6.96, -7.01; P<0.05). In LTCBDE group, the VAS score at postoperative 24 h was 2.6±1.5, which was significantly lower than 3.9±1.2 in T-tube group (t=-3.97, P<0.05). The GIQLI score at postoperative 1 month in LTCBDE group was 115±4, significantly higher than 101±7 in T-tube group (t=10.52, P<0.05). During the postoperative follow-up, 2 cases in each group were found recurrence of calculus. No postoperative complications, such as reflux cholangitis, biliary stricture, nipple stricture and bile duct malignancy occurred. No perioperative death was reported in two groups.

Conclusions

LTCBDE combined with primary suture is a safe and efficacious method for the treatment of choledocholithiasis. Compared with traditional choledochotomy and T-tube drainage, it has multiple advantages such as shorter operation time and faster recovery, etc.

Key words: Choledocholithiasis, Laparoscopes, Primary suture, Drainage

Jiayang Chen, Jiehuan Chen, Shuwen Lin, Weijie Ye, Xi Liu, Kunpeng Hu. Safety and efficacy of laparoscopic transcystic common bile duct exploration combined with primary suture in treatment of choledocholithiasis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(02): 170-173.

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References 20

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组别	例数	年龄（岁，±s）	性别（例，男/女）	胆总管直径（cm，±s）	BMI（kg/m²，±s）	ALT（U/L，±s）
LTCBDE组	36	53±5	17/18	1.5±0.2	30.1±2.0	89±12
T管组	34	51±4	16/19	1.6±0.3	29.3±3.0	94±9
检验值		t=1.84	χ²=0.06	t=-1.65	t=1.32	t=-1.96
P值		0.07	0.81	0.10	0.19	0.05

组别	例数	年龄（岁，±s）	性别（例，男/女）	胆总管直径（cm，±s）	BMI（kg/m²，±s）	ALT（U/L，±s）
LTCBDE组	36	53±5	17/18	1.5±0.2	30.1±2.0	89±12
T管组	34	51±4	16/19	1.6±0.3	29.3±3.0	94±9
检验值		t=1.84	χ²=0.06	t=-1.65	t=1.32	t=-1.96
P值		0.07	0.81	0.10	0.19	0.05

组别	例数	手术时间（min）	术中出血量（ml）	术后住院时间（d）	引流管留置时间（d）
LTCBDE组	36	100±11	12±2	5.1±0.9	4.8±1.4
T管组	34	121±13	11±3	7.0±1.3	5.2±1.6
t值		-6.96	1.11	-7.01	-1.10
P值		<0.01	0.27	<0.01	0.28

组别	例数	手术时间（min）	术中出血量（ml）	术后住院时间（d）	引流管留置时间（d）
LTCBDE组	36	100±11	12±2	5.1±0.9	4.8±1.4
T管组	34	121±13	11±3	7.0±1.3	5.2±1.6
t值		-6.96	1.11	-7.01	-1.10
P值		<0.01	0.27	<0.01	0.28

组别	例数	VAS评分		GIQLI评分
组别	例数	术前	术后24 h	术前	术后1个月
LTCBDE组	36	5.9±1.3	2.6±1.5	94±4	115±4
T管组	34	5.5±1.8	3.9±1.2	95±5	101±7
t值		1.26	-3.97	-1.41	10.52
P值		0.21	<0.01	0.16	<0.01

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