LCBDE术中一期缝合与T管引流的术后胆漏发生率比较OACSTPCD

Objective To compare the incidence of postoperative bile leakage between primary duct closure and T-tube drainage in laparoscopic common bile duct exploration(LCBDE)and investigate the risk factors of postoperative bile leakage.Methods Clinical data of patients who underwent LCBDE in the First Affiliated Hospital of Wenzhou Medical University from Jan.2015 to Nov.2022 were retrospectively analyzed.Patients were divided into the primary closure group and the T-tube drainage group.The risk factors of postoperative bile leakage were analyzed by multivariate Logistic regression in the two groups respectively.The incidence of postoperative bile leakage in the two groups was compared by a propensity score matching(PSM)of 5 indicators,including intrahepatic stones,upper common bile duct stones,maximum stone diameter,highest body temperature,and neutrophil percentage-to-albumin ratio.Results A total of 1 052 patients were included,and 143(13.5%)patients had postoperative bile leakage.Multivariate Logistic regression analysis showed that age>60 years(OR=2.242,95%CI 1.300-4.038,P=0.005)was a risk factor for bile leakage in the primary suture group(n=506),and the chief surgeon performed less than 10 cases of LCBDE(OR=3.525,95%CI 1.469-7.996,P=0.003)was a risk factor for postoperative bile leakage in the T-tube drainage group(n=546).Three hundred eighty-three pairs of patients were successfully matched after a propensity score matching.The incidence of postoperative bile leakage in the primary suture group was higher than that in the T-tube drainage group[15.1%(58/383)vs 9.9%(38/383),P=0.029].Conclusion Age>60 years is an independent risk factor for bile leakage after primary suture and surgeon's inexperience(the chief surgeon performed less than 10 cases of LCBDE)is an independent risk factor for bile leakage after T-tube drainage.Compared with primary suture,T-tube drainage can reduce the incidence of bile leakage after LCBDE.