Clinical Efficacy Analysis Of Primary Suture And T-tube Drainage After Laparoscopic Common Bile Duct Exploration

Objective:This study intends to apply two different methods of T-tube drainage and primary suture for bile duct treatment for patients with choledocholithiasis undergoing laparoscopic common bile duct exploration,and compare relevant clinical data.The clinical effects of both were analyzed.Methods:A total of 84 patients who underwent laparoscopic common bile duct exploration in the Second Department of Hepatopancreatobiliary Surgery,the First Hospital of Jilin University from October 2020 to 2022 were retrospectively analyzed.The patients were divided into T tube drainage group and primary suture group according to surgical method.The preoperative,intraoperative and postoperative conditions of the two groups were compared and analyzed.The data were divided into two parts,namely count type and measurement type.If the measurement type data obey the normal distribution,it was expressed by the mean ± standard deviation and compared by t test.For non-normally distributed measurement data,the median(interquartile range)can be used to express and rank sum test was used to analyze.Categorical data were described as frequencies(percentages)and compared using the chi-square test or Fisher’s exact probability test.The data were processed by SPSS25.0,and P<0.05 was considered statistically significant.Results:There were 48 cases in the T-tube drainage group and 36 cases in the primary suture group.The preoperative general data(preoperative white blood cells,basic diseases,weight,gender,BMI,ASA classification)of the two groups were comparable,and the difference was not statistically significant(P>0.05).The total operation time of the T-tube drainage group was 58.5(48.25,70)minutes,and the total operation time of the primary suture group was 50.5(40.25,61.75)minutes.The difference between the two groups was statistically significant(Z=-2.126,P<0.05),and the primary suture group took less operation time than the T-tube drainage group.There was no significant difference between the two groups in postoperative diet recovery time,drainage tube removal time,white blood cells on the first day after surgery,and postoperative hospital stay(P>0.05).The hospitalization cost of the T-tube drainage group was25369.74(22605.28,32050.01)yuan,and the hospitalization cost of the primary suture group was 23193.74(20786.95,26375.70)yuan,and the difference was statistically significant(Z=-2.639,P<0.05).T tube drainage of patients with postoperative visual analog scale of 5(4,5.75),patients with a suture group 3(2,4);The difference between them was statistically significant(P<0.05).The primary closure group had less hospitalization costs and lower visual analogue scale(VAS)scores.There were 1cases of postoperative bile leakage,4 cases of incision infection,1 case of bleeding and 18 cases of electrolyte disturbance in the T-tube drainage group,and 0 cases of postoperative incision infection,2 cases of bile leakage,0 cases of bleeding and 5cases of electrolyte disturbance in the first-stage suture group.There was no statistical significance between the two groups in terms of incision infection,bile leakage and bleeding(P>0.05);The postoperative electrolyte disturbance and total complications in the primary suture group were better than those in the T-tube group,and the difference was statistically significant(P<0.05).Two groups of social and cultural comfort score(t = 0.308,P = 0.759),environmental comfort score(t = 0.308,P =0.261)there was no significant difference;There were significant differences in the scores of physical comfort(t=-4.620,P < 0.001),psychological comfort(t=-4.62,P <0.001)and total comfort(t=-2.833,P=0.006)between the two groups.The physical comfort dimension,psychological comfort dimension and overall comfort of patients in the primary suture group were significantly better than those in the T-tube drainage group.Conclusions:1.Compared with T tube drainage,LCBDE+ one-stage suture can shorten the operation time,reduce the hospitalization cost and alleviate the postoperative pain of patients.There was no significant difference between the LCBDE+ one-stage suture group and the T-tube drainage group in terms of postoperative incision infection,bile leakage,bleeding,postoperative hospital stay,postoperative diet recovery time,and postoperative drainage tube removal time.The one-stage suture group was superior to the T-tube drainage group in terms of postoperative electrolyte disturbance and total complications.2.There was no significant difference between the two groups in the comfort scores of socio-cultural dimension and environmental dimension,but patients who received LCBDE+ one-stage suture had a higher overall comfort score after surgery than patients with T-tube indwelling,which was specifically reflected in the comfort of physiological dimension and psychological dimension.3.One-stage suture not only guarantees the curative effect of surgical treatment of choledocholithiasis,but also allows patients to avoid pain and inconvenience caused by indenting-T tube,and there is no case of T tube shedding,which greatly reduces the psychological burden of patients and enables them to enjoy a better quality of life,which is more in line with the concept of ERAS and should attract people’s attention.