Clinical Comparative Study Of Two Different T-tube Drainage Positions After Laparoscopic Common Bile Duct Exploration

Objective:Based on the different exit positions of the T-tube after common bile duct exploration,it may play an important role in the patient’s prognosis.We mainly analyze and comparethe clinical efficacy of T-tube through the abdominal rectus incision and the right clavicle midline after the laparoscopic common bile duct exploration(LCBDE).Methods:238 patients with choledocholithiasis(with or without gallstones)were admitted to the Yanan University Affiliated Hospital and were performed with laparoscopic choledocholithotomy and T-tube drainage from November 2017 to October 2019.They were divided into group A(T-tube is placed through the right midline bone)and group B(T-tube is placed through the rectus abdominis)to analyze the data of all patients hospitalized,the following several aspects to compare two groups: 1.Preoperative general information(gender,age,concomitant disease,whether there is calculi incarceration in the lower segment of the common bile duct,whether there is cholangitis and pancreatitis);2.Recent postoperative data of the two groups(bleeding,incision infection,biliary tract infection,bile leakage,perforation,acute pancreatitis,residual calculi,bile leakage after t-tube extraction,biliary peritonitis,bile duct stricture,and time for choledochoscopy);3.Laboratory tests before and after surgery in both groups,including alanine aminotransferase(ALT),aspartate aminotransferase(AST),direct bilirubin(DBiL),total bilirubin(TBiL),hemoglobin concentration(Hb),and white blood cell count(WBC);4.The hospitalization status(hospitalization time,operation time and total hospitalization cost)of the two groups;5.Long-term effects include the presence or absence of recurrence of choledocholithiasis and the presence of chronic cholangitis.Results : 1.The preoperative data before surgery were not statistically significant.(P>0.05);2.In the recent data,Postoperative bleeding,incision infection,biliary tract infection,bile leakage,perforation,acute pancreatitis,residual stones,bile duct stenosis,were not statistically significant in the two groups.(P> 0.05);Bile leakage occurred in 8 cases after T tube removal in group A,group B patients had 1 case bile leakage after T tube removal;3 cases of biliary peritonitis after T tube removal in group A,1cases of biliary peritonitis after T tube remova in Group B;Time taken for choledochoscopy after T tube removal in group A(43.6±2.5min),Group B time for choledochoscopy(34.2±2.7min);Bile leakage after T tube removal,and the time taken for choledochoscopy were statistically significant in both groups(P <0.05).3.The laboratory examinations before and after surgery were not statistically significant in both groups(P> 0.05);4.The hospitalization status(hospitalization time,surgical time,and total hospitalization costs)were not statistically significant in both groups(P> 0.05);5.Long-term effects were not statistically significant(P> 0.05).Conclusion:The extraction of T-tube through rectus abdominis after laparoscopic common bile duct exploration did not increase the risk of postoperative bile leakage,nor did the length of hospital stay,operation time,and total hospitalization cost increase;The time of choledochoscopy was obviously shortened during the postoperative choledochoscopy.Therefore,after laparoscopic common bile duct exploration,T-tube placement through the rectus abdominis port is safer and more reliable than the right midclavicular approach.It has obvious advantages and is cost-effective,and it is worth recommending for the majority of clinicians.