腹腔镜胆总管探查取石联合胆囊切除术后一期缝合与T管引流临床疗效比较的荟萃分析

doi:10.16139/j.1007-9610.2025.02.10

摘要/Abstract

摘要：

目的: 系统评价腹腔镜下胆总管探查取石联合胆囊切除术后一期缝合与T管引流两种胆总管闭合方式在治疗胆总管结石合并胆囊结石的优缺点。方法: 通过计算机检索PubMed、中国期刊全文数据库、中国万方数据库、中国维普数据库等，检索时间2012年1月1日至2021年12月31日，按照纳入及排除标准筛选研究文献，采用Review Manager 5.4软件进行荟萃分析。结果: 共纳入10篇文献，收集1 589例病人，其中一期缝合组783例，T管引流组806例。荟萃分析结果显示：一期缝合能缩短手术时间[MD=-15.59，95%CI：（-23.74，-7.45），P=0.000 2]，减少手术中出血量[MD=-6.49，95%CI：（-12.74，-0.24），P=0.04]，提早恢复胃肠道功能[MD=-0.39，95%CI：（-0.60，-0.19），P=0.000 2]，减少术后住院时间[MD=-1.41，95%CI：（-2.19，-0.62），P=0.000 4]，减少住院费用[SMD=-0.66，95%CI：（-1.21，-0.12），P=0.02]。结论: 两种胆总管闭合方式在治疗胆总管结石合并胆囊结石都是安全有效的。但一期缝合组相比于T管引流组，具有手术时间短、术中出血量少、术后住院时间短、住院费用低等优点，值得临床推广。

关键词: 胆总管结石, 腹腔镜胆总管探查取石, 一期缝合, T管引流

Abstract:

Objective To systematically evaluate the comparative efficacy of primary closure versus T-tube drainage following laparoscopic common bile duct exploration (LCBDE) and extraction combined with cholecystectomy in the management of choledocholithiasis with concomitant cholecystolithiasis.Methods A comprehensive search of databases including PubMed, CNKI, Wanfang, and VIP was conducted from January 1, 2012, to December 31, 2021. Eligible studies were screened based on predefined inclusion/exclusion criteria, and meta-analysis was performed using Review Manager 5.4 software.Results Ten studies involving 1 589 patients (783 primary closure vs. 806 T-tube drainage) were included. Meta-analysis demonstrated that primary closure significantly reduced operation time [MD = -15.59, 95% CI: (-23.74, -7.45), P = 0.000 2], intraoperative blood loss [MD = -6.49, 95% CI: (-12.74, -0.24), P = 0.04], postoperative gastrointestinal recovery time [MD = -0.39, 95% CI: (-0.60, -0.19), P= 0.000 2], postoperative hospital stay [MD = -1.41, 95% CI: (-2.19, -0.62), P = 0.000 4], and hospitalization costs [SMD = -0.66, 95% CI: (-1.21, -0.12), P = 0.02].Conclusions Both closure methods are safe and effective for choledocholithiasis with cholecystolithiasis. However, primary closure offers advantages including shorter operative duration, reduced blood loss, decreased hospital stay, and lower costs, warranting broader clinical adoption.

Key words: Common bile duct stone, Laparoscopic common bile duct exploration(LCBDE) and extraction, Primary closure（PC）, T-tube drainage(TD)

中图分类号:

R657.42

王平, 包卉, 宋振顺. 腹腔镜胆总管探查取石联合胆囊切除术后一期缝合与T管引流临床疗效比较的荟萃分析[J]. 外科理论与实践, 2025, 30(2): 151-158.

WANG Ping, BAO Hui, SONG Zhenshun. Meta-analysis of comparative clinical outcomes between primary closure and T-tube drainage following laparoscopic common bile duct exploration and extraction combined with cholecystectomy[J]. Journal of Surgery Concepts & Practice, 2025, 30(2): 151-158.

图/表 13

图1

表1

纳入文献信息汇总表

Inclusion study	Year of publi- cation	Research time	Closing mode	case- load	Male/fe- male (e-xample)	Operation time (min)	Intraoperative blood loss（mL）	Extubation time（d）	Gastrointestinal reco-very time (d)	Total post operative hospital stay (d)	Total hospital expenses (Yuan)	Bile leakage	pancreati- tis	Stone residue	Recurrence of stone	stricture
HUANG Bo,et al	2021	2014-2019	PC	50	30/20	91.24±8.18	23.92±5.78	4.90±0.81	2.41±0.49	-	-	4	-	1	1	-
			TD	82	47/35	98.68±10.20	25.02±6.57	4.43±0.65	2.54±0.53	-	-	1	-	2	10	-
LI Wenxin,et al	2019	2015-2017	PC	33	22/11	99.61±11.7	67.92±14.58	-	2.58±0.59	-	24 600±2 900	1	1	1	1	-
			TD	37	24/13	102.34±10.46	69.64±15.24	-	4.23±0.81	-	24 900±3 200	4	0	2	0	-
LIAN Yuanshu,et al	2020	2015-2019	PC	48	21/27	-	-	3.5±0.3	0.6±0.1	-	-	1	-	0	2	-
			TD	52	26/26	-	-	4.3±0.4	0.7±0.1	-	-	3	-	2	4	-
LIANG Kuo,et al	2017	2012-2016	PC	63	29/34	86.5±21.5	28.6±22	4.3±3.8	-	7.6±4.3	-	8	-	2	-	-
			TD	52	30/22	94.4±20.3	36.2±27.2	4.4±1.6	-	10.9±6.6	-	1	-	5	-	-
MA Daxi,et al	2018	2014-2016	PC	89	54/35	108.25±34.91	26.56±10.18	-	-	7.48±3.17	21 200±5 500	7	1	2	-	1
			TD	88	42/46	131.06±67.29	29.57±11.11	-	-	7.61±2.48	24 100±7 100	4	1	3	-	0
SHEN Biao,et al	2018	2012-2016	PC	204	118/86	94.27±24.34	25.11±6.37	2.71±1.09	0.87±0.26	5.91±1.08	-	6	-	-	-	3
			TD	204	112/92	133.25±45.78	39.17±5.84	3.44±1.53	1.26±0.31	7.07±1.42	-	4	-	-	-	4
ZHANG Weijie,et al	2015	2000-2009	PC	47	22/25	106.0±22.6	-	-	-	5.1±1.6	10 317.3±735.8	2	1	3	-	-
			TD	46	19/27	126.4±29.5	-	-	-	8.4±2.8	11 634.3±1 133.3	7	0	1	-	-
DONG Zhitao,et al	2014	2002-2012	PC	101	43/58	102.6±15.2	35.2±14.5	-	0.89±0.23	3.2±2.1	112 78.9±479.1	5	1	4	-	-
			TD	93	40/53	128.6±20.4	45.2±17.4	-	1.08±0.41	4.9±3.2	12 436.7±879.3	4	0	3	-	-
XIAO Lin-kang,et al	2018	2014-2016	PC	114	58/56	105.46±5.77	-	-	-	7.60±0.80	21 927.20±772.02	3	-	-	-	0
			TD	116	62/54	106.71±5.19	-	-	-	7.79±0.85	22 059.90±697.98	2	-	-	-	0
LI Zhiyu,et al	2015	2013-2014	PC	34	15/19	109.6±35.8	-	-	2.4±0.8	-	26 258.9±4 168.2	4	-	0	0	0
			TD	36	14/22	127.3±34.0	-	-	2.6±0.9	-	27 844.4±8 714.9	4	-	1	1	1

表1

图2

图3

图4

图5

图6

图7

图8

图9

图10

图11

图12

参考文献 17

[1]	吴在德, 吴孟超. 黄家驷外科学[M]. 北京: 人民卫生出版社, 2008.
	WU Z D, WU M C. Huang Jiasi’s Textbook of Surgery[M]. Beijing: People’s Medical Publishing House, 2008.
[2]	马大喜, 李可为, 程明荣, 等. LC+LCBDE胆总管一期缝合与T管引流治疗胆囊胆总管结石的随机对照研究[J]. 海南医学, 2018, 29(7):930-934.
	MA D X, LI K W, CHENG M R, et al. A randomized controlled trial of primary suture versus T-tube drainage in laparoscopic cholecystectomy and common bile duct exploration for cholecystocholedocholithiasis[J]. Hainan Med J, 2018, 29(7):930-934.
[3]	DONG Z T, WU G Z, LUO K L, et al. Primary closure after laparoscopic common bile duct exploration versus T-tube[J]. J Surg Res, 2014, 189(2):249-254.
[4]	XIAO L K, XIANG J F, WU K, et al. The reasonable drainage option after laparoscopic common bile duct exploration for the treatment of choledocholithiasis[J]. Clin Res Hepatol Gastroenterol, 2018, 42(6):564-569.
[5]	ZHANG W J, XU G F, HUANG Q, et al. Treatment of gallbladder stone with common bile duct stones in the laparoscopic era[J]. BMC surgery,2015, 15:7
[6]	黄博, 陈一帆, 翟敏, 等. 胆总管结石术后一期缝合与T管引流的疗效对比及复发因素分析[J]. 中国医刊, 2021, 56(9):980-984.
	HUANG B, CHEN Y F, ZHAI M, et al. Comparison of curative effect of primary suture and T-tube drainage after choledocholithiasis and analysis of recurrence factors[J]. Chin Med J, 2021, 56(9):980-984.
[7]	沈彪, 宋振顺. 腹腔镜胆总管探查联合免T管一期缝合术治疗胆总管结石的疗效研究[J]. 湖南师范大学学报(医学版), 2018, 15(3):69-71.
	SHEN B, SONG Z S. Curative effect of laparoscopic choledochal exploration combined with one-stage T-tube-free suture in the treatment of choledocholithiasis[J]. J Hunan Norm Univ(Med Ed), 2018, 15(3):69-71.
[8]	李志钰, 尹飞飞, 孙世波. 腹腔镜胆总管探查取石一期缝合与T管引流的临床对比研究[J]. 腹腔镜外科杂志, 2015, 20(3):215-218.
	LI Z Y, YIN F F, SUN S B. A comparative study of laparoscopic primary suture and T-tube drainage for common bile duct exploration[J]. J Laparosc Surg, 2015, 20(3):215-218.
[9]	梁阔, 刘东斌, 刘家峰, 等. 老年患者腹腔镜胆总管探查一期缝合与T管引流的临床疗效分析[J]. 腹腔镜外科杂志, 2017, 22(10):774-777.
	LIANG K, LIU D B, LIU J F, et al. Clinical efficacy analysis of primary suture and T-tube drainage in elderly patients with laparoscopic common bile duct exploration[J]. J Laparosc Surg, 2017, 22(10):774-777.
[10]	练远书, 黄高, 陆开艺, 等. 两种手术方法对胆总管直径≥1.0 cm结石患者的疗效分析[J]. 中华普外科手术学杂志(电子版), 2020, 14(5):530-533.
	LIAN Y S, HUANG G, LU K Y, et al. Efficacy analysis of two surgical methods for patients with choledocholithiasis ≥1.0 cm in diameter[J]. Chin J Gen Surg(Electron Ed), 2020, 14(5):530-533.
[11]	李文心, 何忠野, 王开宇, 等. 三种不同微创方式治疗胆总管结石不伴有胆囊结石的疗效观察[J]. 河北医学, 2019, 25(10):1718-1721.
	Li W X, He Z Y, Wang K Y, et al. Observation on the efficacy of three different minimally invasive methods in the treatment of common bile duct stones without gallbladder stones[J]. Hebei Med, 2019, 25(10):1718-1721.
[12]	PETELIN J B. Laparoscopic approach to common duct pathology[J]. Am J Surg, 1993, 165(4):487-491. pmid: 8480888
[13]	ZHOU H, WANG S, FAN F, et al. Primary closure with knotless barbed suture versus traditional T-tube drainage after laparoscopic common bile duct exploration: a single-center medium-term experience[J]. J Int Med Res, 2020, 48(1):300060519878087.
[14]	ZHEN W, XU ZHEN W, NAN TAO F, et al. Primary closure versus T-tube drainage following laparoscopic common bile duct exploration in patients with previous bilia-ry surgery[J]. Am Surg, 2021, 87(1):50-55.
[15]	STOKER M E, LEVEILLEE R J, MCCANN J C JR, et al. Laparoscopic common bile duct exploration[J]. J Laparoendosc Surg, 1991, 1(5):287-293. pmid: 1834281
[16]	PANG L, WU S, KONG J. Laparoscopic transcystic common bile duct exploration (LTCBDE): a safer method to treat common bile duct stones than laparoscopic choledochotomy[J]. Rev Esp Enferm Dig, 2020, 112(6):507-508. doi: 10.17235/reed.2020.6679/2019 pmid: 32496116
[17]	GUAN H, JIANG G, MAO X. Primary duct closure combined with transcystic drainage versus T‐tube drainage after laparoscopic choledochotomy[J]. ANZ J Surg, 2019, 89(7-8):885-888.