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Abstract：
OBJECTIVE: The aim of this retrospective study was to explore the indications for three minimally invasive approaches-T-tube external drainage, double J-tube internal drainage, and primary closure-in laparoscopic cholecystectomy combined with common bile duct exploration.
METHODS: Three hundred eighty-nine patients with common bile duct stones who were treated at the Second People\'s Hospital of Hefei between February 2018 and January 2023 were retrospectively included. Patients were divided into three groups based on the surgical approach used: the T-tube drainage group, the double J-tube internal drainage group, and the primary closure group. General data, including sex, age, and BMI, were compared among the three groups preoperatively. Surgical time, length of hospital stay, pain scores, and other aspects were compared among the three groups. Differences in liver function, inflammatory factors, and postoperative complications were also compared among the three groups.
RESULTS: There were no significant differences among the three groups in terms of sex, age, BMI, or other general data preoperatively (P > 0.05). There were significant differences between the primary closure group and the T-tube drainage group in terms of surgical time and pain scores (P < 0.05). The primary closure group and double J-tube drainage group differed from the T-tube drainage group in terms of length of hospital stay, hospitalization expenses, and time to passage of gas (P <0.05). Among the three groups, there were no statistically significant differences in inflammatory factors or liver function, TBIL, AST, ALP, ALT, GGT, CRP, or IL-6, before surgery or on the third day after surgery (P > 0.05). However, on the third day after surgery, liver function in all three groups was significantly lower than that before surgery (P<0.05). In all three groups, the levels of CRP and IL-6 were significantly lower than their preoperative levels. The primary closure group had significantly lower CRP and IL-6 levels than did the T-tube drainage group (P < 0.05). The primary closure group differed from the T-tube drainage group in terms of the incidences of bile leakage and electrolyte imbalance (P < 0.05). The double J-tube drainage group differed from the T-tube drainage group in terms of the tube dislodgement rate (P < 0.05).
CONCLUSIONS: Although primary closure of the bile ducts has clear advantages in terms of length of hospital stay and hospitalization expenses, it is associated with a higher incidence of postoperative complications, particularly bile leakage. T-tube drainage and double J-tube internal drainage also have their own advantages. The specific surgical approach should be selected based on the preoperative assessment, indications, and other factors to reduce the occurrence of postoperative complications.
METHODS: Three hundred eighty-nine patients with common bile duct stones who were treated at the Second People\'s Hospital of Hefei between February 2018 and January 2023 were retrospectively included. Patients were divided into three groups based on the surgical approach used: the T-tube drainage group, the double J-tube internal drainage group, and the primary closure group. General data, including sex, age, and BMI, were compared among the three groups preoperatively. Surgical time, length of hospital stay, pain scores, and other aspects were compared among the three groups. Differences in liver function, inflammatory factors, and postoperative complications were also compared among the three groups.
RESULTS: There were no significant differences among the three groups in terms of sex, age, BMI, or other general data preoperatively (P > 0.05). There were significant differences between the primary closure group and the T-tube drainage group in terms of surgical time and pain scores (P < 0.05). The primary closure group and double J-tube drainage group differed from the T-tube drainage group in terms of length of hospital stay, hospitalization expenses, and time to passage of gas (P <0.05). Among the three groups, there were no statistically significant differences in inflammatory factors or liver function, TBIL, AST, ALP, ALT, GGT, CRP, or IL-6, before surgery or on the third day after surgery (P > 0.05). However, on the third day after surgery, liver function in all three groups was significantly lower than that before surgery (P<0.05). In all three groups, the levels of CRP and IL-6 were significantly lower than their preoperative levels. The primary closure group had significantly lower CRP and IL-6 levels than did the T-tube drainage group (P < 0.05). The primary closure group differed from the T-tube drainage group in terms of the incidences of bile leakage and electrolyte imbalance (P < 0.05). The double J-tube drainage group differed from the T-tube drainage group in terms of the tube dislodgement rate (P < 0.05).
CONCLUSIONS: Although primary closure of the bile ducts has clear advantages in terms of length of hospital stay and hospitalization expenses, it is associated with a higher incidence of postoperative complications, particularly bile leakage. T-tube drainage and double J-tube internal drainage also have their own advantages. The specific surgical approach should be selected based on the preoperative assessment, indications, and other factors to reduce the occurrence of postoperative complications.
摘要：
目的：这项回顾性研究的目的是探讨三种微创方法-T管外引流术的适应症，双J管内部引流,腹腔镜胆囊切除术联合胆总管探查的初次闭合。
方法：回顾性分析2018年2月至2023年1月合肥市第二人民医院收治的三百八十九例胆总管结石患者。根据所采用的手术方式将患者分为三组：T管引流组，双J管内引流组,和主闭包组。一般数据,包括性,年龄,BMI,术前比较三组。手术时间,住院时间,疼痛评分,等方面进行比较。肝功能的差异，炎症因子，比较3组术后并发症。
结果：三组在性别方面无显著差异，年龄,BMI,术前或其他一般资料(P>0.05)。初次闭合组与T管引流组在手术时间、疼痛评分方面比较差异均有统计学意义(P<0.05)。初次闭合组和双J管引流组与T管引流组在住院时间上不同,住院费用,气体通过时间(P<0.05)。在三组中，炎症因子或肝功能无统计学差异,TBIL,AST,ALP,ALT,GGT,CRP,术前或术后第3天IL-6水平(P>0.05)。然而,手术后的第三天,3组肝功能均显著低于术前(P<0.05)。在所有三组中，CRP和IL-6水平明显低于术前水平。与T管引流组比较,初次封堵组CRP和IL-6水平显著降低(P<0.05)。初次封堵组与T管引流组在胆漏和电解质紊乱发生率方面差异有统计学意义(P<0.05)。双J管引流组与T管引流组的脱管率比较差异有统计学意义(P<0.05)。
结论：尽管胆管的初次闭合在住院时间和住院费用方面具有明显的优势，它与较高的术后并发症发生率有关，尤其是胆漏.T管引流和双J管内部引流也各有优势。应根据术前评估选择具体的手术入路，适应症,等因素,减少术后并发症的发生。
方法：回顾性分析2018年2月至2023年1月合肥市第二人民医院收治的三百八十九例胆总管结石患者。根据所采用的手术方式将患者分为三组：T管引流组，双J管内引流组,和主闭包组。一般数据,包括性,年龄,BMI,术前比较三组。手术时间,住院时间,疼痛评分,等方面进行比较。肝功能的差异，炎症因子，比较3组术后并发症。
结果：三组在性别方面无显著差异，年龄,BMI,术前或其他一般资料(P>0.05)。初次闭合组与T管引流组在手术时间、疼痛评分方面比较差异均有统计学意义(P<0.05)。初次闭合组和双J管引流组与T管引流组在住院时间上不同,住院费用,气体通过时间(P<0.05)。在三组中，炎症因子或肝功能无统计学差异,TBIL,AST,ALP,ALT,GGT,CRP,术前或术后第3天IL-6水平(P>0.05)。然而,手术后的第三天,3组肝功能均显著低于术前(P<0.05)。在所有三组中，CRP和IL-6水平明显低于术前水平。与T管引流组比较,初次封堵组CRP和IL-6水平显著降低(P<0.05)。初次封堵组与T管引流组在胆漏和电解质紊乱发生率方面差异有统计学意义(P<0.05)。双J管引流组与T管引流组的脱管率比较差异有统计学意义(P<0.05)。
结论：尽管胆管的初次闭合在住院时间和住院费用方面具有明显的优势，它与较高的术后并发症发生率有关，尤其是胆漏.T管引流和双J管内部引流也各有优势。应根据术前评估选择具体的手术入路，适应症,等因素,减少术后并发症的发生。
