LCBDE术后一期缝合与T管引流治疗老年胆总管结石的效果比较

目的 探讨腹腔镜胆总管切开探查取石术（LCBDE）并一期缝合与LCBDE并T管引流治疗老年胆总管结石的临床疗效。方法 回顾性分析汕头市中心医院2017 年1 月至2018 年12 月收治的符合入选标准的老年（年龄≥60 岁）胆总管结石患者158 例，所有患者均行LCBDE术，其中130 例术后行一期缝合（一期缝合组），28 例行T管引流（T管引流组）。比较两组的术前基线资料、手术时间、术中出血量、术后住院时间、住院费用、术后并发症发生率、结石复发率等资料。结果 两组术前基线资料比较，差异无统计学意义（P＞0.05）。一期缝合组在手术时间、术后住院时间方面明显短于T管引流组，差异有统计学意义（P＜0.05）；两组患者在术中出血量、住院总费用、术后并发症发生率、结石复发率方面比较，差异无统计学意义（P＞0.05）。结论 老年（年龄≥60岁）并不是腹腔镜胆总管切开探查取石术并一期缝合的绝对禁忌。正确把握手术适应证及禁忌证，对于合适的老年患者，腹腔镜胆总管切开探查取石术并一期缝合也是安全可行的。

Comparison of clinical effects between primary common bile duct closure and T-tube drainage after laparoscopic common bile duct exploration for elderly patients with choledocholithiasis

Objective To compare the clinical effects of primary common bile duct closure and T-tube drainage after laparoscopic common bile duct exploration (LCBDE) for elderly patients with choledocholithiasis.Methods The clinical data of 158 elderly patients with choledocholithiasis performed LCBDE from Jan. 2017 to Dec. 2018 were collected and analyzed retrospectively. According to the operation procedure after LCBDE, patients were divided into primary common bile duct closure group (n=130) and T-tube drainage group (n=28). The preoperative baseline data, operation time, blood loss, postoperative hospitalization time, total hospitalization costs, postoperative complications incidence and stone recurrence rate were compared between the two groups.Results There was no difference between two groups in terms of gender, age, hypertension, diabetes, choledochal diameter, preoperative total bilirubin, alanine aminotransferase (P>0.05). The primary common bile duct closure group was superior to T-tube drainage group on operation time and postoperative hospitalization time (P<0.05). And there was no difference between the two groups on blood loss, total hospitalization costs, postoperative complications incidence and recurrence rate of stones (P>0.05). Conclusion Elderly (age≥60 years) is not an absolute contraindication for primary common bile duct closure after LCBDE. With correctly understanding the indications and contraindications, primary common bile duct closure after LCBDE is also safe and feasible for elderly patients with choledocholithiasis.