복강경 총담관탐색술에서 담관절개창의일차봉합군과 T관 삽입군의 치료성적 비교 (Comparison of Primary Closure and T-tube Drainagefollowing Laparoscopic CBD Exploration)

서지정보

· 발행기관 : 대한외과학회
· 수록지 정보 : Annals of Surgical Treatment and Research / 77권 / 6호 / 399 ~ 403페이지
· 저자명 : 노경태, 민석기, 이현국

초록

Purpose: Laparoscopic common bile duct exploration (LCBDE) has traditionally been accompanied by T-tube drainage. However, patients must carry it for several weeks and often suffer problems related to the T-tube. So, primary closure of CBD has been proposed as a safe and effective alternative to T-tube placement after laparoscopic choledochotomy. The aim of this study was to compare primary closure versus T-tube drainage after LCBDE.
Methods: Between January 2000 and December 2005, 63 patients suffering from choledocholithiasis underwent LCBDE successfully through choledochotomy. Those patients were devided into two groups; primary closure group (group P) and T-tube placement group (group T). Patients’ clinical characeristics, postoperative outcome and follow up data were compared between the two groups.
Results: Of 63 patients, 30 (48.6%) had primary closure of the choledochotomy and 33 (52.4%) had T-tube drainage. Stone clearance rate was 100% in both groups. The mean operation time and the incidence of postoperative complications had no significant difference between the two groups. The mean postoperative hospital stay (8.8 vs. 16.4 days, P＜0.001) was significantly shorter in the P group compared to the T group. Each group had one recurrent CBD stone. None of both groups showed symptoms or signs associated with CBD stricture during the follow up period.
Conclusion: Primary closure of choledochotomy after LCBDE can prevent the disadvantages associated with T-tube and lead to a shorter hospital stay. Therefore, primary closure should be considered as a safe alternative method after LCBDE.

영어초록

Purpose: Laparoscopic common bile duct exploration (LCBDE) has traditionally been accompanied by T-tube drainage. However, patients must carry it for several weeks and often suffer problems related to the T-tube. So, primary closure of CBD has been proposed as a safe and effective alternative to T-tube placement after laparoscopic choledochotomy. The aim of this study was to compare primary closure versus T-tube drainage after LCBDE.
Methods: Between January 2000 and December 2005, 63 patients suffering from choledocholithiasis underwent LCBDE successfully through choledochotomy. Those patients were devided into two groups; primary closure group (group P) and T-tube placement group (group T). Patients’ clinical characeristics, postoperative outcome and follow up data were compared between the two groups.
Results: Of 63 patients, 30 (48.6%) had primary closure of the choledochotomy and 33 (52.4%) had T-tube drainage. Stone clearance rate was 100% in both groups. The mean operation time and the incidence of postoperative complications had no significant difference between the two groups. The mean postoperative hospital stay (8.8 vs. 16.4 days, P＜0.001) was significantly shorter in the P group compared to the T group. Each group had one recurrent CBD stone. None of both groups showed symptoms or signs associated with CBD stricture during the follow up period.
Conclusion: Primary closure of choledochotomy after LCBDE can prevent the disadvantages associated with T-tube and lead to a shorter hospital stay. Therefore, primary closure should be considered as a safe alternative method after LCBDE.

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