| Objectives Through a retrospective study of 104 cases of laparoscopic cholecystectomy(LC)+laparoscopic common bile duct exploration(LCBDE)+T-tube drainage in Hebei General Hospital,analyze the basic conditions before extubation at different times(3?4 weeks,?4 weeks and ?6 weeks,>6 weeks),the occurrence of complications after extubation and other factors,we want to find out the most appropriate extubation time and related factors that may reduce the duration of extubation,so as to guide clinical treatment and prevent complications,and minimize the pain caused by T-tube to patients.Methods From October 2016 to October 2018,the data of patients with cholelithiasis and choledocholithiasis treated by LC+LCBDE+T-tube drainage in the Hepatobiliary,Pancreaticobiliary and Splenic surgery area of Hebei General Hospital were collected,and the patients with liver function grade C and end-stage choledocholithiasis were excluded.According to the different time of removing T-tube,it was divided into the 3?4 weeks group(A group),?4 weeks and ?6 weeks group(B group)and>6 weeks group(C group).At the same time,the relevant case data of each group were collected and classified.SPSS 24.0 statistical software was used for data processing.The mean ± standard deviation was used to describe the measurement data of normal distribution.If the variance was uniform,one-way ANOVA was used to test the difference,and LSD method was used to compare the pair-wise comparison.If the variance was not uniform or non normal distribution,the median(interquartile spacing)[M(QR)]was used to describe the measurement data,and the nonparametric rank sum test of multiple independent samples was used to test the difference,and the post hoc test method is used for pair-to-pair comparison.The counting data were expressed by the rate(%).The ?2 test of R×C table was used to test the difference between the composition ratio and the rate,and the bonferroni correction method of multiple independent samples was used for pairwise comparison.The test level ?=0.05,P<0.05 was statistically significant.Logistic regression analysis was used to study the influencing factors of different T-tube removal time among the three groups.According to the grouping situation of this study,logistic regression analysis with ordered multi classification was selected.The test level ?=0.05,P<0.05 was statistically significant.The results were analyzed by comparing different statistics between groups and combining clinical knowledge.Results A total of 104 patients were included in this study,including 4 cases of postoperative residual bile duct calculi,which were excluded into group A(14 cases),group B(43 cases)and group C(43 cases).There was no complete normal distribution among the three groups of statistics,so the nonparametric rank ?2 sum test of several independent samples was used for the measurement data,and the test was used for the enumeration data.There were statistically significant differences between the three groups in age and fatty liver(P=0.009,P=0.011),and no statistically significant differences among the other items(P>0.05).After pairwise comparison,it can be concluded that:Age:the difference between groups A and C was statistically significant(Pcorrection=0.001),while the difference between groups A and B and between groups B and C was not statistically significant(Pcorrection=0.065,Pcorrection=0.043).Fatty liver:the difference between groups A and C was statistically significant(PFisher=0.010),while the difference between groups A and B and between groups B and C was not statistically significant(PFisher=0.053,PFishet=0.501).Comparison of different statistics among the three groups showed that:Among the five items including the operator,postoperative hypoproteinemia,total t-tube drainage volume,t-tube clamping time and total cost,there were statistically significant differences among the three groups(P<0.001,P=0.037,P<0.001,P=0.006,P=0.023),and there was no statistically significant difference among other items(P>0.05).After pairwise comparison,it can be concluded that:Operator(chief physician/associate chief physician):there were statistically significant differences between groups A and C and between groups B and C(Pcorrection=0.005,Pcorrection<0.001),and no statistically significant differences between groups A and B(PFisher=0.634).Postoperative hypoproteinemia:there were statistically significant differences between groups B and C(Pcorrection=0.011),and no statistically significant differences between groups A and B or between groups A and C(PFisher=0.391,PFisher=0.511).The total drainage volume of t-tube was statistically significant between groups A and B,between groups A and C,and between groups B and C(Pcorrection=0.002,Pcorrection<0.001,Pcorrection=0.004).The clamping time of t-shaped tube:the difference between groups A and C was statistically significant(Pcorrection=0.002),and the difference between groups A and B and between groups B and C was not statistically significant(Pcorrection=0.090,Pcorrection=0.051).Total cost:there was no statistically significant difference between groups A and B,between groups A and C,or between groups B and C(Pcorrection=0.634,Pcorrection=0.033,Pcorrection=0.018).In the further multiple logistic regression analysis,there were statistically significant differences in age,total drainage volume of T-tube and operator(P=0.011,P=0.009,P<0.001),and no statistically significant differences in other items(P>0.05).Conclusions Removal of T-tube was safe in 3?4 weeks after laparoscopic cholecystectomy+choledocholithotomy+T-tube drainage.For the elderly,patients with more T-tube drainage flow and hypoproteinemia,extubation can be extended to 6 weeks.Figure[0];Table[6];Reference[111]... |
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