Application of primary closure of common bile duct in laparoscopic and choledochoscopic treatment of gallstone disease complicated with common bile duct stones
Objective:To evaluate the application of primary closure of common bile duct in the laparoscopic and choledochoscopic treatment of gallstone disease complicated with common bile duct stones.Methods:Clinical data of 320 patients with gallstone disease complicated with common bile duct stones treated in Punan Hospital from July 2018 to December 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 186 patients were male and 134 female, aged from 38 to 53 years, with a median age of 46 years. According to the random number table method, all patients were randomly divided into the primary closure (n=160) and T-tube drainage groups (n=160). Four-port laparoscopic cholecystectomy was performed, common bile duct was incised, and primary closure of common bile duct and T-tube drainage were performed after choledochoscopic lithotomy. Perioperative conditions and postoperative complications were observed between two groups. The operation time and length of postoperative hospital stay were compared by t test. The incidence of postoperative complications was compared by Chi-square test.Results:The surgeries were completed successfully in all the patients, without conversion to open surgery. In the primary closure group, the average operation time, length of postoperative hospital stay and hospitalization expense were (100±9) min, (12.4±1.6) d and (2.9±0.3)×104 Yuan, significantly lower than (113±11) min, (18.3±2.7) d and (3.5±0.5)×104 Yuan in the T-tube drainage group (t=-4.545, -0.485, -3.577; P<0.05).The total incidence of postoperative complications was 11.3%(18/160) in the primary closure group and 10.0%(16/160) in the T-tube drainage group, where no significant difference was observed (χ2=0.131, P>0.05).Conclusions:Primary closure of common bile duct is safe and effective in the laparoscopic and choledochoscopic treatment of gallstone disease complicated with common bile duct stones. Compared with T-tube drainage, it has multiple advantages including shorter operation time, faster postoperative recovery, lower hospitalization expense and less invasiveness.
万方数据
