腹腔镜下胆管切开取石一期胆管缝合应用于高龄患者的安全性探讨

目的：探讨腹腔镜下胆管切开取石后一期缝合胆管而不放置胆管引流在高龄患者中的安全性和可行性。方法回顾性分析2007年1月至2012年10月接受腹腔镜下胆管切开取石后不放置胆管引流的高龄病例临床资料，共16例作为研究组，收集同时期接受腹腔镜下胆管切开取石不放置胆管引流管的非高龄病例20例作为对照组。对比分析两组患者的平均手术时间、住院时间、术后并发症情况等。结果两组患者术后均康复出院。研究组平均手术时间为（116.31±11.31）min，平均住院时间（10.19±1.22）d；而对照组平均手术时间为（106.80±10.58）min，平均住院时间（7.65±0.88）d；两组比较差异无统计学意义。两组均无胆漏、腹腔出血、膈下感染及术后阻塞性黄疸等术后并发症。两组的切口感染、肺部感染率和结石复发率差异无统计学意义。结论腹腔镜下胆管切开取石后一期缝合胆管而不放置胆管引流用于高龄患者是安全、可行的。

Laparoscopic common bile duct exploration with primary closure for management of choledoch-olithiasis in elder patients

Objective To investigate the safety and feasibility of laparoscopic common bile duct exploration （LCBDE） with primary closure for management of choledocholithiasis in elder patients. Methods The clinical data of sixteen elder patients with choledocholithiasis who underwent primary closure of the common bile duct （without T-tube drainage） after LCBDE （group A） was compared with 20 non-elder patients who underwent the same procedure （group B）. Both groups were evaluated with regard to operation time, hospital stay, and postoperative complications. Results The mean operation time was （116.31±11.31） minutes for group A and （106.80±10.58） minutes for group B;the hospital stay was （10.19±1.22） days for group A and （7.65±0.88） days for group B;both factors showed no significant difference. There were no bile leakage, abdominal bleeding, subphrenic infection and obstructive jaundice after operation in both groups. And there was no significant difference in incision infection, pulmonary infection and recurrence of stones in both groups. Conculsion It is safe and feasible for elder patients to have primary closure of the common bile duct without T-tube drainage after laparoscopic choledochotomy.