老年肝结石和/或胆总管结石患者腹腔镜胆总管探查术后t管引流与初步闭合的比较：一项使用倾向评分匹配的比较研究

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Hpb Pub Date : 2025-02-01 DOI:10.1016/j.hpb.2024.11.004

Phu V. La , Hieu T. Le , Thang M. Tran , Quan M. Tran , Phuc V. La , Vu A. Doan

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引用次数: 0

摘要

背景：腹腔镜胆总管探查（LCBDE）常用于肝结石和/或胆总管结石，但胆总管闭合的理想方法仍不确定，特别是对于老年患者（≥65岁）。本研究比较了老年患者LCBDE术后首次闭合与t管引流的结果。方法：分析2016年5月至2020年12月在越南两家医院接受肝内胆管结石和/或胆总管结石手术的老年患者的数据。患者分为A组（t管引流，n = 52）和B组（一期闭合，n = 57）。使用倾向评分匹配（PSM）来调整基线特征，比较两组之间的短期和长期结果。结果：PSM获得56例匹配患者。psm前，A组手术时间和住院时间较B组长（p = 0.001）。A组术后并发症发生率较高（17.9% vs. 7.1%），但差异无统计学意义（p = 0.422）。A组也有更复杂的胆结石。psm后，B组手术时间和住院时间较短。至于长期结果，结石复发率相似（5.8% vs. 3.5%, p = 0.668）。结论：LCBDE术后一期闭合是治疗老年肝内胆管结石和/或胆总管结石安全有效的替代方法。

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Primary closure compared with T-tube drainage following laparoscopic common bile duct exploration among elderly patients with hepatolithiasis and/or choledocholithiasis: a comparative study using a propensity score matching

Background

Laparoscopic common bile duct exploration (LCBDE) is commonly used for hepatolithiasis and/or choledocholithiasis, but the ideal method for common bile duct closure remains uncertain, especially for elderly patients (≥65 years). This study compared outcomes of primary closure versus T-tube drainage following LCBDE in elderly patients.

Methods

Data from elderly patients undergoing LCBDE for hepatolithiasis and/or choledocholithiasis between May 2016 and December 2020 at two Vietnamese hospitals were analyzed. Patients were divided into groups A (T-tube drainage, n = 52) and B (primary closure, n = 57). Propensity score matching (PSM) was utilized to adjust for baseline characteristics, comparing short- and long-term outcomes between groups.

Results

PSM yielded 56 matched patients. Pre-PSM, group A had longer operating times and hospital stays than Group B (p = 0.001). Group A had higher postoperative complications (17.9 % vs. 7.1 %) but was not statistically significant (p = 0.422). Group A also had more complex biliary stones. Post-PSM, Group B maintained shorter operating times and hospital stays. Regarding long-term results, stone recurrence rates were similar (5.8 % vs. 3.5 %, p = 0.668).

Conclusion

Primary closure following LCBDE is a safe and effective alternative to T-tube drainage for treating hepatolithiasis and/or choledocholithiasis in elderly patients.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).