关键词: 胆总管结石, 老年人, 腹腔镜下胆总管探查术, 一期缝合, T管引流

Abstract: Objective To investigate the therapeutic effects of primary suture of the common bile duct under laparoscope and T tube drainage in the treatment of the elderly patients with choledocholithiasis. Methods A total of 135 elderly patients with common bile duct stones admitted to the Department of General Surgery, Nanjing Hospital Affiliated to Nanjing Medical University from January 2017 to January 2021 were enrolled. According to the suture method of the common bile duct, the patients were divided into primary suture group (n=64) and T-tube drainage group (n=71). The general data, preoperative examination data, intraoperative exploration findings and postoperative recovery of the patients in the two groups were compared and analyzed. Results There were no significant differences between the two groups in general conditions, first symptoms, preoperative examinations, the average common bile duct diameter, tube wall thickness and mean intraoperative blood loss (P>0.05). The average duration of the operation in the primary suture group was shorter than that in the T-tube drainage group (P<0.05). There were no significant differences in the time of first ventilation, hospital stay and the incidence rate of postoperative biliary fistula between the two groups (P>0.05). One case received re-operation due to severe biliary fistula in the primary suture group. In the T-tube drainage group, one patient's T-tube slipped off after being discharged from the hospital, and another 3 cases suffered from a biliary fistula when the T-tube was removed. Conclusions The primary suture of the common bile duct under laparoscope will not lead to an increase of complications, and at the same time, it can improve the comfort and satisfaction of the patients after treatment. It is a safe and effective method for the treatment of the elderly patients with choledocholithiasis.

Key words: choledocholithiasis, aged, laparoscopic common bile duct exploration, primary suture, T-tube drainage