담도절개 후 단순일차봉합과 T-관 삽입배액술의 비교
Clinical Consideration of Choledocholithiasis Treatment; Analysis of Primary Closure versus T-tube Drainage after Choledochotomy
소속 상세정보
정금오/Chung GO
권정남/박동은/소병준/채권묵/Kwon JN/Park DE/So BS/Chae KM
KMID : 0371320030650010055
Abstract
Purpose: The placement of a drainage tube in the common bile duct, following a choledochotomy, has become accepted as routine procedure since it was first reported by Abbe, in 1892. However, many complications are associated with T-tube drainage, such as bile peritonitis after its removal, accidental dislodgement, bile leakage from the T-tube track and a high incidence of postoperative bacteremia, have been reported. This study was designed to evaluate the primary closure as a suitable surgical technique in placce of T-tube drainage following a choledochotomy.
Methods: Between January and December 2002, primary closures were performed in 41 cases and T tube drainage in 112, following a choledochotomy. These cases were divided into 2 groups (group A: primary closure, and group B: T-tube drainage). The medical records of the patients were reviewed, and the following data analyzed - age, sex, preoperative laboratory value, intraoperative finding, postoperative laboratory value, complication, and days of postoperative hospital stay.
Results: There was no significant differences observed in the data of the investigated parameters, with the exception of the mean post-operative hospital stay. The mean post-operative hospital stays were 11.82 and 18.08 days in groups A and B (P=0.0034), respectively. The complication rates on each group showed no statistical difference. However bile peritonitis or bile leakage after T-tube removal developed 5 cases from group B. there were 2 and 5 deaths due to MODS & ARDS, respectively.
Conclusion: A primary closure, following a choledochotomy, may be a suitable alternative technique to T-tube drainage under reasonable conditions.
키워드
Primary closure; Choledochotomy; 담도의 일차적 봉합; 담도절개술
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