关键词: 腹腔镜胆总管探查术, 肝硬化, 胆管结石, 疗效, 影响因素

Abstract: Objective To investigate the efficacy of primary suture after laparoscopic common bile duct exploration (LCBDE) in the treatment of liver cirrhosis complicated with bile duct stones and the impact factors on postoperative prognosis.Methods One hundred and twenty-four cases of liver cirrhosis complicated with bile duct stones who were operated in hepatobiliary surgery of Suining Central Hospital from March 2020 to March 2022 were analyzed retrospectively. According to the random number table method, all patients were divided into a control group (N=62 cases) and a study group (N=62 cases). LCBDE was performed in both groups. Patients in the control group were treated with T-tube drainage, and patients in the study group were primary sutured after operation. The perioperative indexes and postoperative complications of these two groups were observed. Pain visual analogue scale (VAS) score were obtained at 24 hours after operation. The influencing factors for postoperative prognosis were analyzed by logistic regression.Results When compared the patients in the control group with those in the study group, the intraoperative bleeding volumes were not statistically significant (P>0.05). The drainage times for patients in the study group (4.95±0.22 d) were longer than those of the control group (4.42±0.26 d) (P<0.05). The opertation times (90.16±8.12 min) and hospital stays (5.19±1.16 d) of patients in the study group were shorter than those of 99.2±9.14 min and 7.62±1.26 d, respectively, in the control group (P<0.05); The incidence of postoperative complications was 11.29% in the study group, which had no significant difference than that of 9.68% in the control group (P>0.05); The VAS score of the study group was lower than that of the control group (P<0.05). By univariate analysis it was showed that complicated with basic diseases, diameter of common bile duct, total number of cases operated by the chief surgeon, and T-tube drainage were the influencing factors for a poorer effect of primary suture after LCBDE (P<0.05), while gender, age, ASA score, neutrophil count, CRP and preoperative bilirubin level, bile duct suture mode and bile duct stone number were not the influencing factors (P>0.05). By logistic regression analysis it was showed that the combination of basic diseases, the diameter of common bile duct <1 cm, the number of cases operated by the chief surgeon< 28, and T-tube drainage were independent high-risk factors for poor primary suture effect after LCBDE (P<0.05).Conclusion Compared with T-tube drainage, one-stage suture after LCBDE has the advantages of a shorter operation time, less postoperative pain and a shorter hospital stay, without causing poor postoperative effect. Complicated with basic diseases, common bile duct diameter <1cm, operated cases < 28 by the chief surgeon, T-tube drainage were independent risk factors for a poorer primary suture outcome after LCBDE.

Key words: Laparoscopic common bile duct exploration, Cirrhosis, Bile duct stones, Curative effect, Influence factor