摘要
AIM: Transcystic biliary decompression (TCBD) has been proposed as an alternative to T-tube placement after laparoscopic choledochotomy (LCD). This permits safe primary closure of the choledochotomy and eliminates the complications associated with T-tubes. TCBD tube has been secured by Roeder knots and transfixation, and removed later than 3 wk after surgery. We presented a modified TCBD (mTCBD) method after LCD using the ureteral catheter and the Lapro-Clip (David and Geck, Danbury, Connecticut, USA), and compared it with T-tube drainage.METHODS: Between October 2002 and June 2003, patients with choledocholithiasis undergoing LCD with mTCBD (mTCBD Group, n = 30) were retrospectively compared to those undergoing LCD with T-tube drainage (T-tube Group,n = 52) at a single institution.RESULTS: There were no significant differences in operative time and retained stones between the two groups. Patients in mTCBD group had a significantly decreased average output of bile compared with those in T-tube group (306±141 vs 409±243 mL/24 h, P=0.000). Removal of dra in tubes inmTCBD group was done significantly earlier than that in T-tube group (median, 5 vs 29 d, P=0.000). No complication related to drain tubes was found in mTCBD group, and morbidity rate with the T-tube was significantly higher (11.5%), and bile leakage following T-tube removal was 5.8%.CONCLUSION: A modified TCBD after LCD is safe, effective and easy to perform. It may reduce postoperative complications, especially bile leakage.
AIM:Transcystic biliary decompression(TCBD)has been proposed as an alternative to T-tube placement after laparoscopic choledochotomy(LCD).This permits safe primary closure of the choledochotomy and eliminates the complications associated with T-tubes.TCBD tube has been secured by Roeder knots and transfixation,and removed later than 3 wk after surgery.We presented a modified TCBD (mTCBD)method after LCD using the ureteral catheter and the Lapro-Clip(David and Geck,Danbury,Connecticut,USA), and compared it with T-tube drainage. METHODS:Between October 2002 and June 2003,patients with choledocholithiasis undergoing LCD with mTCBD (mTCBD Group,n=30)were retrospectively compared to those undergoing LCD with T-tube drainage(T-tube Group, n=52)at a single institution. RESULTS:There were no significant differences in operative time and retained stones between the two groups.Patients in mTCBD group had a significantly decreased average output of bile compared with those in T-tube group(306±141 vs 409±243 mL/24 h,P=0.000).Removal of drain tubes in mTCBD group was done significantly earlier than that in T- tube group(median,5 vs 29 d,P=0.000).No complication related to drain tubes was found in mTCBD group,and morbidity rate with the T-tube was significantly higher(11.5%),and bile leakage following T-tube removal was 5.8%. CONCLUSION:A modified TCBD after LCD is safe,effective and easy to perform.It may reduce postoperative complications, especially bile leakage.
