The effect of primary suture in patients with choledocholithiasis undergoing laparoscopic common bile duct exploration with different common duct diameters
10.3760/cma.j.cn431274-20240219-00270
- VernacularTitle:不同胆总管直径的胆总管结石患者行腹腔镜下胆总管探查一期缝合的效果观察
- Author:
Jie WANG
1
;
Shaochuan YANG
;
Qing ZHOU
Author Information
1. 张家口市第一医院普外科，张家口 075000
- Publication Type:Journal Article
- Keywords:
Choledocholithiasis;
Bile duct diameters;
Laparoscopic cholecystectomy;
Laparoscopic common bile duct exploration;
Primary suture
- From:
Journal of Chinese Physician
2024;26(12):1824-1829
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the effect of laparoscopic primary suture in patients with choledocholithiasis of different common duct diameters.Methods:The clinical data of 99 patients with choledocholithiasis who received laparoscopic cholecystectomy (LC)+ laparoscopic common bile duct exploration (LCBDE) primary suture in the Zhangjiakou First Hospital from April 2020 to January 2022 were retrospectively analyzed, and according to different choledocholithiasis diameters they were divided into group A ( n=40, common bile duct diameter >8 mm), group B ( n=34, common bile duct diameter >6-8 mm), group C ( n=25, common bile duct diameter >4-6 mm). All patients were treated with intravenous anesthesia combined with LC+ LCBDE suture. General data, surgical indexes, liver function, stress response, immune function and postoperative complications were compared among the three groups. Results:There were no significant differences in gender, number of cases with acute mild cholangitis, age, body mass index and number of common bile duct stones among 3 groups (all P>0.05).There were no significant differences in operation success rate, operation time, conversion rate and intraoperative blood loss among the 3 groups (all P>0.05). 24 hours after surgery, serum alanine aminotransferase (ALT), total bilirubin (TBIL), aspartate aminotransferase (AST) [(58.46±7.12)U/L, (32.87±4.32)μmol/L, (67.59±8.60)U/L] in the group A were higher than those in the group B [(49.02±6.58)U/L, (26.54±3.40)μmol/L, (48.01±6.52)U/L], in the group C [(37.85±4.60)U/L, (21.06±2.17)μmol/L, (36.38±4.56)U/L] (all P<0.05). The levels of ALT, TBIL and AST in the group B were higher than those in the group C (all P<0.05). 24 hours after surgery, serum adrenocorticotropic hormone (ACTH) and cortisol (Cor) in the group A [(19.24±4.76)ng/ml, (148.04±14.30)ng/ml] were higher than those in the group B [(16.91±3.72)ng/ml, (131.24±11.65)ng/ml] and in the group C [(14.60± 2.83)ng/ml, (119.87±8.06)ng/ml] (all P<0.05). Serum ACTH and Cor levels in the group B were higher than those in the group C (all P<0.05). 24 hours after surgery, Serum immunoglobulin M (IgM) and immunoglobulin A (IgA) [(0.65±0.10)ng/ml, (1.07±0.25)ng/ml] in the group A were lower than those in the group B [(0.85±0.19)ng/ml, (1.35±0.29)ng/ml] and in the group C [(0.92±0.24)ng/ml, (1.60±0.34)ng/ml] (all P<0.05). Serum IgM and IgA levels in the group B were lower than those in the group C (all P<0.05). There were no significant differences in biliary leakage rate, incision infection rate, choledocholithiasis recurrence rate, peritoneal infection rate, pulmonary infection rate and postoperative bile duct stenosis rate among 3 groups (all P>0.05). Conclusions:Patients with choledocholithiasis with different common duct diameters can be treated with LC+ LCBDE one-stage suture with significant effect, which will not affect postoperative complications. However, the larger the diameter, the more the recovery of liver function will be affected, the stress reaction will be aggravated, and the immune function will be reduced.
