Clinical Application Of J-tube Drainage In Bile Duct Exploration

Objective:A comparison of laparoscopic common bile duct exploration with one-stage biliary tract suture with J-tube drainage and endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy was performed,to observe the intraoperative and postoperative indices of the two kinds of operation for cholelithiasis complicated with extrahepatic bile duct calculi,Objective to investigate whether the first-stage suture bile duct and J-tube drainage in the postoperative period of laparoscopic common bile duct exploration accord with the concept of ERAS.Methods:Retrospective analysis from November 2015 to May 2017,collected from our department,and by the same group of doctor respectively laparoscopic cholecystectomy with endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy(control group),laparoscopic cholecystectomy with laparoscopic common bile duct exploration with one-stage biliary tract suture with J-tube drainage(observation Group)of chronic cholecystitis complicated with cholecystolithiasis,The patients with common bile duct stones were investigated and collected the following data: 1.The patients’ age,sex,duration of course,the diameter of bile duct,preoperative bilirubin,preoperative transaminase,whether or not to combine the complication of the basal complication and pancreatitis were collected to evaluate the preoperative general situation.2.To collect operation time,postoperative hospitalization time,extubation time,the incidence rate of postoperative short-term complications(bile leakage,acute pancreatitis,acute biliary tract infection,gastrointestinal bleeding,perforation,etc.).3.To collect two groups of patients with regular follow-up information to understand the quality of life and whether there are long-term complications(duodenal papilla stenosis,recurrence of stones,acute cholangitis,etc.).Results:1.There were no significant differences between the two groups before operation,all the test indexes and complications were not statistically significant(p>0.05)and comparable.2.By comparison,the operation time of J-Tube Drainage group(136.88±26.27)minutes was shorter than the ERCP group(159.69±32.61)minutes;the extubation time of J-Tube Drainage group(4.84±1.16)days,compared with the ERCP group(6.02±1.10)days was shorter.However,there was no statistically significant difference(p>0.05).The J-Tube Drainage Group(3/49)was lower than that in the ERCP group(0/53),but there was no statistically significant difference(p>0.05).On the hospitalization expenses,postoperative hospitalization time and postoperative short-term complication rate,the J-tube drainage group was superior to the ERCP group,and the difference was statistically significant(p<0.05).3.The two groups of patients were followed up for 6-24 months,the average 16 months.The two groups were no duodenal papilla stenosis,and acute cholangitis.There were two cases of ERCP group recurrence,while J-Tube Drainage group No stone recurrence,which was no statistically significant difference(p<0.05).Conclusion:Both types of surgery have the advantages of short operation time,rapid postoperative recovery,and high success rate of operation.But laparoscopic common bile duct exploration with one-stage biliary tract suture with J-tube drainage can make patients with postoperative complications of lower risk,so that patients recover earlier and cost less,and fully embodies the advantages of minimally invasive surgery,more in line with the ERAS concept.