一期缝合与T管引流治疗复发性胆总管结石的效果及安全性分析

任敏强; 王万超; 崔树青; 孟晓东; 刘四清

doi:10.12449/JCH260722

一期缝合与T管引流治疗复发性胆总管结石的效果及安全性分析

DOI: 10.12449/JCH260722

任敏强^{1, 2},
王万超¹,
崔树青²,
孟晓东³,
刘四清^1, , ,

1.
华北理工大学附属医院肝胆胰外科一科，河北唐山 063000
2.
唐山市丰南区医院外三科，河北唐山 063300
3.
华北理工大学附属医院肝胆胰外科二科，河北唐山 063000

基金项目:

河北省医学科学研究课题计划项目 (20250927)

伦理学声明：本研究方案于2025年12月12日经由华北理工大学附属医院伦理委员会审批通过，伦理批号：KY20251212024。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：任敏强负责课题设计，资料分析及撰写论文；王万超负责指导写作思路及论文修改；崔树青、孟晓东负责收集病例及数据，统计学分析，绘制图表；刘四清负责指导撰写文章并最后定稿。

详细信息

通信作者:
刘四清， siqingliu@163.com （ORCID： 0000-0001-8745-0490）

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出版历程
- 收稿日期: 2025-12-19
- 录用日期: 2026-04-09
- 出版日期: 2026-07-25

Efficacy and safety of primary duct closure versus T-tube drainage in treatment of recurrent choledocholithiasis

1.
First Department of Hepatopancreatobiliary Surgery，The Affiliated Hospital of North China University of Science and Technology，Tangshan，Hebei 063000，China
2.
Third Department of Surgery，Tangshan Fengnan District Hospital，Tangshan，Hebei 063300，China
3.
Second Department of Hepatopancreatobiliary Surgery，The Affiliated Hospital of North China University of Science and Technology，Tangshan，Hebei 063000，China

Research funding:

Medical Science Research Project Plan of Hebei Province (20250927)

More Information

Corresponding author: Liu Siqing， siqingliu@163.com （ORCID： 0000-0001-8745-0490）

摘要

摘要: 目的为复发性胆总管结石（RCL）患者行腹腔镜胆总管探查术（LCBDE）后合理选择胆总管闭合方式提供临床参考依据。方法回顾性分析2022年2月—2025年12月华北理工大学附属医院肝胆胰外科收治的121例行LCBDE治疗RCL患者的临床资料。根据胆总管闭合方式的不同，将患者分为一期缝合组（PDC组，n=58）和T管引流组（TTD组，n=63）。比较两组患者的手术时间、术后第1天引流量、术后第3天总胆红素水平、术后恢复进食时间、术后拔除引流管时间、术后1周胆总管直径、术后住院时间、住院总费用及并发症情况，并分析术后并发症的危险因素。计量资料两组间比较采用成组t检验或Mann-Whitney U检验，计数资料两组间比较采用χ²检验或Fisher精确检验。采用多因素Logistic回归分析术后并发症的影响因素。结果 PDC组的手术时间［48.50（39.00～59.25）min vs 55.00（46.00～69.00）min，Z=-2.726，P=0.006］、术后第3天总胆红素水平［17.25（14.43～21.30）μmol/L vs 20.06（16.40～29.30）μmol/L，Z=-2.950，P=0.003］、术后恢复进食时间［1（1～1）d vs 1（1～2）d，Z=-4.506，P<0.001］、术后拔除引流管时间［7（7～7）d vs 8（8～9）d，Z=-9.693，P<0.001］、术后住院时间［8（8～8）d vs 10（9～11）d，Z=-8.960，P<0.001］、住院总费用［21 750（20 369～23 310）元vs 24 889（23 438～26 920）元，Z=-5.572，P<0.001］均显著低于TTD组，PDC组的术后1周胆总管直径［1.0（0.9～1.1）cm vs 1.0（1.0～1.1）cm，Z=-2.064，P=0.039］较TTD组更接近正常胆道生理解剖结构。PDC组总并发症发生率（10.34% vs 26.98%，P=0.024）、电解质紊乱发生率（1.72% vs 15.87%，P=0.006）均显著低于TTD组。多因素Logistic回归分析显示，术前胆总管直径<1.3 cm、术前总胆红素水平≥21.0 μmol/L是患者出现术后并发症的独立危险因素，而一期缝合术式为术后并发症的独立保护因素（P值均<0.05）。结论在严格把握适应证的前提下，RCL患者行LCBDE后采用PDC可加快康复、降低并发症与住院成本，临床应用更具优势。
- 胆总管结石病 /
- 一期缝合 /
- T管引流 /
- 治疗学
Abstract: Objective To provide a clinical reference for rational selection of the methods for common bile duct closure after laparoscopic common bile duct exploration （LCBDE） in patients with recurrent choledocholithiasis （RCL）. Methods A retrospective analysis was performed for the clinical data of 121 patients with RCL who underwent LCBDE in the Department of Hepatopancreatobiliary Surgery， The Affiliated Hospital of North China University of Science and Technology， from February 2022 to December 2025， and according to the method for common bile duct closure， the patients were divided into primary duct closure group （PDC group with 58 patients） and T-tube drainage group （TTD group with 63 patients）. The two groups were compared in terms of time of operation， drainage volume on day 1 after surgery， total bilirubin level on day 3 after surgery， time to diet after surgery， time to drainage tube removal after surgery， common bile duct diameter at 1 week after surgery， length of postoperative hospital stay， total hospitalization costs， and complications， and the risk factors for postoperative complications were analyzed. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. The multivariate Logistic regression analysis was used to identify influencing factors for postoperative complications. Results Compared with the TTD group， the PDC group had a significantly shorter time of operation ［48.50 （39.00 — 59.25） min vs 55.00 （46.00 — 69.00） min， Z=-2.726， P=0.006］， a significantly lower level of total bilirubin on day 3 after surgery ［17.25 （14.43 — 21.30） μmol/L vs 20.06 （16.40 — 29.30） μmol/L， Z=-2.950， P=0.003］， a significantly shorter time to diet after surgery ［1 （1 — 1） d vs 1 （1 — 2） d， Z=-4.506， P<0.001］， a significantly shorter time to drainage tube removal after surgery ［7 （7 — 7） d vs 8 （8 — 9） d， Z=-9.693， P<0.001］， a significantly shorter length of postoperative hospital stay ［8 （8 — 8） d vs 10 （9 — 11） d， Z=-8.960， P<0.001］， and significantly lower total hospitalization costs ［21 750 （20 369 — 23 310） yuan vs 24 889 （23 438 — 26 920） yuan， Z=-5.572， P<0.001］， and common bile duct diameter at 1 week after surgery in the PDC group was closer to the normal physiological anatomical structure of the biliary tract compared with that in the TTD group ［1.0 （0.9 — 1.1） cm vs 1.0 （1.0 — 1.1） cm， Z=-2.064， P=0.039］. Compared with the TTD group， the PDC group had significantly lower incidence rates of total complications （10.34% vs 26.98%， P=0.024） and electrolyte disturbance （1.72% vs 15.87%， P=0.006）. The multivariate logistic regression analysis showed that common bile duct diameter <1.3 cm before surgery and total bilirubin level ≥21.0 μmol/L before surgery were independent risk factors for postoperative complications， while primary duct closure was an independent protective factor against postoperative complications （P<0.05）. Conclusion Under the premise of strict control of indications， PDC after LCBDE for RCL patients can accelerate recovery and reduce complications and hospitalization costs， thereby demonstrating greater advantages in clinical application.
- Choledocholithiasis /
- Primary Duct Closure /
- T-Tube Drainage /
- Therapeutics

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表 1 两组术前一般资料比较

Table 1. Comparison of baseline data of the two groups

项目	PDC组（n=58）	TTD组（n=63）	统计值	P值
性别［例（%）］			χ²=0.077	0.782
男	30（51.72）	31（49.21）
女	28（48.28）	32（50.79）
年龄（岁）	65.62±12.48	67.25±10.58	t=0.779	0.438
ASA分级［例（%）］			χ²=0.116	0.733
Ⅰ级	18（31.03）	13（20.64）
Ⅱ级	21（36.21）	33（52.38）
Ⅲ级	19（32.76）	17（26.98）
BMI（kg/m²）	22.19±2.27	22.86±2.08	t=1.692	0.093
高血压［例（%）］	20（34.48）	20（31.75）	χ²＝0.102	0.749
糖尿病［例（%）］	9（15.52）	15（23.81）	χ²=1.306	0.253
心脏病［例（%）］	5（8.62）	3（4.76）		0.478^1）
术前总胆红素（μmol/L）	24.55（18.17～32.38）	25.60（19.20～34.50）	Z=-0.890	0.374
胆总管术前直径（cm）	1.2（1.0～1.3）	1.2（1.0～1.3）	Z=-0.428	0.669
注：PDC，一期缝合；TTD，T管引流；ASA，美国麻醉医师协会；BMI，体重指数。1）Fisher精确检验。

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表 2 两组术后资料比较

Table 2. Comparison of postoperative data of the two groups

项目	PDC组（n=58）	TTD组（n=63）	Z值	P值
术后第3天总胆红素（μmol/L）	17.25（14.43～21.30）	20.06（16.40～29.30）	-2.950	0.003
术后恢复进食时间（d）	1（1～1）	1（1～2）	-4.506	<0.001
术后拔除引流管时间（d）	7（7～7）	8（8～9）	-9.693	<0.001
术后住院时间（d）	8（8～8）	10（9～11）	-8.960	<0.001
术后第1天引流量（mL）	10.00（5.00～12.75）	10.00（5.00～15.00）	-1.087	0.277
住院总费用（元）	21 750（20 369～23 310）	24 889（23 438～26 920）	-5.572	<0.001
术后1周胆总管直径（cm）	1.0（0.9～1.1）	1.0（1.0～1.1）	-2.064	0.039
注：PDC，一期缝合；TTD，T管引流。

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表 3 术后并发症情况

Table 3. Postoperative complications

术后并发症	PDC组（n=58）	TTD组（n=63）	P值^1）
胆漏［例（%）］	2（3.45）	1（1.59）	0.611
切口感染［例（%）］	3（5.17）	2（3.17）	0.669
消化道出血［例（%）］	0（0.00）	1（1.59）	0.483
电解质紊乱［例（%）］	1（1.72）	10（15.87）	0.006
肺炎［例（%）］	0（0.00）	1（1.59）	0.483
肝脓肿［例（%）］	0（0.00）	1（1.59）	0.483
心功能不全［例（%）］	0（0.00）	1（1.59）	0.483
总并发症［例（%）］	6（10.34）	17（26.98）	0.024
注：1）Fisher精确检验。PDC，一期缝合；TTD，T管引流。

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表 4 术后并发症危险因素分析

Table 4. Analysis of postoperative complication risk factors

临床资料	有并发症（n=23）	无并发症（n=98）	统计值	P值
性别［例（%）］			χ²=0.035	0.851
男	12（52.17）	49（50.00）
女	11（47.83）	49（50.00）
年龄（岁）	68.39±10.56	66.02±11.73	t=-0.888	0.376
合并症［例（%）］	14（60.87）	46（46.94）	χ²=1.446	0.229
高血压［例（%）］			χ²=0.473	0.492
有	9（39.13）	31（31.63）
无	14（60.87）	67（68.37）
2型糖尿病［例（%）］			χ² =2.007	0.157
有	7（30.43）	17（17.35）
无	16（69.57）	81（82.65）
心脏病［例（%）］				0.359^1）
有	0（0.00）	8（8.16）
无	23（100.00）	90（91.84）
术前胆总管直径［例（%）］			χ²=5.686	0.017
≥1.3 cm	12（52.17）	26（26.53）
<1.3 cm	11（47.83）	72（73.47）
术前总胆红素［例（%）］			χ²=6.272	0.012
≥21.0 μmol/L	20（86.96）	58（59.18）
<21.0 μmol/L	3（13.04）	40（40.82）
手术时长（min）	59.00（45.00～68.00）	51.00（42.00～62.00）	Z=-1.415	0.157
ASA分级［例（%）］			χ²=1.009	0.315
≤2级	19（82.61）	71（72.45）
>2级	4（17.39）	27（27.55）
BMI［例（%）］			χ²=0.012	0.911
≤24 kg/m²	16（69.57）	67（68.37）
>24 kg/m²	7（30.43）	31（31.63）
手术方式［例（%）］			χ²=5.431	0.020
一期缝合	6（26.09）	52（53.06）
T管引流	17（73.91）	46（46.94）
注：ASA，美国麻醉医师协会；BMI，体重指数。1）Fisher精确检验。

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表 5 术后并发症的多因素Logistic分析

Table 5. Multivariate Logistic analysis of postoperative complications

变量	β值	SE	Wald χ²	OR（95%CI）	P值
术前胆总管直径（<1.3 cm=1，≥1.3 cm=0）	1.541	0.619	6.200	4.671（1.388～15.715）	0.013
术前总胆红素水平（≥21.0 μmol/L=1，<21.0 μmol/L=0）	1.485	0.660	5.058	4.415（1.210～16.103）	0.025
手术方式（一期缝合=1，T管引流=0）	-1.160	0.540	4.611	0.314（0.109～0.904）	0.032
注：OR，比值比；CI，置信区间。

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参考文献(38)

[1]	Buxbaum J L, Abbas Fehmi S M, Sultan S, et al. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis[J]. Gastrointest Endosc, 2019, 89( 6): 1075- 1105.e15. DOI: 10.1016/j.gie.2018.10.001.
[2]	Wen N Y, Wang Y Q, Cai Y L, et al. Risk factors for recurrent common bile duct stones: A systematic review and meta-analysis[J]. Expert Rev Gastroenterol Hepatol, 2023, 17( 9): 937- 947. DOI: 10.1080/17474124.2023.2242784.
[3]	Wang S F, Wu C H, Sung K F, et al. The impact of metabolic factors and lipid-lowering drugs on common bile duct stone recurrence after endoscopic sphincterotomy with following cholecystectomy[J]. J Pers Med, 2023, 13( 10): 1490. DOI: 10.3390/jpm13101490.
[4]	Peng L J, Cheng X N, Zhang L. Risk factors of stone recurrence after endoscopic retrograde cholangiopancreatography for common bile duct stones[J]. Medicine, 2020, 99( 27): e20412. DOI: 10.1097/MD.0000000000020412.
[5]	Wu Y, Zhang Y, Jiang X M, et al. Risk factors for single and multiple recurrences for endoscopic retrograde cholangiopancreatography and open choledochotomy in treating choledocholithiasis[J]. Gastroenterol Res Pract, 2023, 2023: 4738985. DOI: 10.1155/2023/4738985.
[6]	Zhao Haiying. Treatment options for recurrent common bile duct stones[J]. Chin J Pract Surg, 2024, 44( 3): 277- 281. DOI: 10.19538/j.cjps.issn1005-2208.2024.03.09. 赵海鹰. 复发性胆总管结石治疗选择[J]. 中国实用外科杂志, 2024, 44( 3): 277- 281. DOI: 10.19538/j.cjps.issn1005-2208.2024.03.09.
[7]	Yang Yu, Yunfu Lyu, Zheng Jinfang. Research progress in effect of endoscopic sphincterotomy of the sphincter of Oddi on gallbladder function[J/OL]. Chin J Hepatic Surg Electron Ed, 2024, 13( 2): 235- 238. DOI: 10.3877/cma.j.issn.2095-3232.2024.02.020. 杨渝, 吕云福, 郑进方. 内镜下Oddi括约肌切开取石术后对胆囊功能影响的研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13( 2): 235- 238. DOI: 10.3877/cma.j.issn.2095-3232.2024.02.020.
[8]	Zhou Y, Zha W Z, Zhang Y P, et al. Treatment for recurrent choledocholithiasis: Endoscopic? or laparoscopic? A prospective cohort study[J]. Surg Endosc, 2025, 39( 2): 868- 874. DOI: 10.1007/s00464-024-11436-z.
[9]	Kang H. Sample size determination and power analysis using the G*Power software[J]. J Educ Eval Health Prof, 2021, 18: 17. DOI: 10.3352/jeehp.2021.18.17.
[10]	Wang Xueguo, Li Dongming, WU Lei, et al. A comparative study of laparoscopic choledocholithotomy with primary suture and T-tube drainage[J]. J Hepatobiliary Surg, 2019, 27( 3): 194- 197. DOI: 10.3969/j.issn.1006-4761.2019.03.011. 王学国, 黎东明, 吴雷, 等. 腹腔镜下胆总管切开取石一期缝合与T管引流对比研究[J]. 肝胆外科杂志, 2019, 27( 3): 194- 197. DOI: 10.3969/j.issn.1006-4761.2019.03.011.
[11]	Zhou Jia, Yang Lu, Sun Zhenghao, et al. Research progress on the relationship between biliary microbiome and common bile duct stones[J]. Chin J Dig, 2025, 45( 5): 351- 355. DOI: 10.3760/cma.j.cn311367-20231228-00232. 周佳, 杨璐, 孙正豪, 等. 胆道微生态与胆总管结石相关性研究进展[J]. 中华消化杂志, 2025, 45( 5): 351- 355. DOI: 10.3760/cma.j.cn311367-20231228-00232.
[12]	Tao Qin, Zheng Liang, Luo Hui, et al. Analysis of bile bacterial diversity in patients with recurrent common bile duct stones[J]. Chin J Dig Endosc, 2022, 39( 10): 827- 832. DOI: 10.3760/cma.j.cn321463-20211018-00483. 陶芹, 郑亮, 罗辉, 等. 复发性胆总管结石患者的胆汁菌群多样性分析[J]. 中华消化内镜杂志, 2022, 39( 10): 827- 832. DOI: 10.3760/cma.j.cn321463-20211018-00483.
[13]	Liu Q, Zheng L Y, Wang Y, et al. Primary choledocholithiasis occurrence and recurrence is synergetcally modulated by the bile microbiome and metabolome alternations[J]. Life Sci, 2023, 331: 122073. DOI: 10.1016/j.lfs.2023.122073.
[14]	Li Jiqiang, Zhang Guixin. Research advances in the risk factors for recurrence of common bile duct stone after choledocholithotomy[J]. J Clin Hepatol, 2023, 39( 1): 231- 237. DOI: 10.3969/j.issn.1001-5256.2023.01.036. 李积强, 张桂信. 胆总管取石术后结石复发危险因素的研究进展[J]. 临床肝胆病杂志, 2023, 39( 1): 231- 237. DOI: 10.3969/j.issn.1001-5256.2023.01.036.
[15]	Andreozzi P, de Nucci G, Devani M, et al. The high rate of spontaneous migration of small size common bile duct stones may allow a significant reduction in unnecessary ERCP and related complications: Results of a retrospective, multicenter study[J]. Surg Endosc, 2022, 36( 5): 3542- 3548. DOI: 10.1007/s00464-021-08676-8.
[16]	Chen Jian, Xia Kaijian, Gao Fuli, et al. Development of a predictive model and application for spontaneous passage of common bile duct stones based on automated machine learning[J]. J Clin Hepatol, 2025, 41( 3): 518- 527. DOI: 10.12449/JCH250319. 陈健, 夏开建, 高福利, 等. 基于自动化机器学习构建胆总管结石自发排石预测模型及应用程序[J]. 临床肝胆病杂志, 2025, 41( 3): 518- 527. DOI: 10.12449/JCH250319.
[17]	Zhu Shuo, Wu Rongxiang, Che Jinhui, et al. Clinical efficacy observation of laparoscopic partial hepatectomy versus laparoscopic common bile duct exploration for the treatment of patients with intrahepatic bile duct stones[J]. Chin J Med Offic, 2025, 53( 1): 85- 87, 91. DOI: 10.16680/j.1671-3826.2025.01.20. 朱硕, 仵荣祥, 车金辉, 等. 腹腔镜下肝部分切除肝内胆管结石治疗术与胆总管探查取石肝内胆管结石治疗术治疗肝内胆管结石患者临床疗效观察[J]. 临床军医杂志, 2025, 53( 1): 85- 87, 91. DOI: 10.16680/j.1671-3826.2025.01.20.
[18]	Tian H L, Zhou J, Bai D S, et al. Comparison of repeated recurrence of common bile duct stones and occurrence of hepatolithiasis after synchronous laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration or with endoscopic sphincterotomy: A 10-year retrospective study[J]. J Gastrointest Surg, 2023, 27( 6): 1167- 1176. DOI: 10.1007/s11605-023-05645-5.
[19]	Cianci P, Restini E. Management of cholelithiasis with choledocholithiasis: Endoscopic and surgical approaches[J]. World J Gastroenterol, 2021, 27( 28): 4536- 4554. DOI: 10.3748/wjg.v27.i28.4536.
[20]	Zhu T F, Lin H M, Sun J, et al. Primary duct closure versus T-tube drainage after laparoscopic common bile duct exploration: A meta-analysis[J]. J Zhejiang Univ Sci B, 2021, 22( 12): 985- 1001. DOI: 10.1631/jzus.B2100523.
[21]	Zhu T F, Zhu K, Sun J, et al. The clinical effect of primary duct closure and T-tube drainage: A propensity score matched study[J]. Asian J Surg, 2023, 46( 8): 3046- 3051. DOI: 10.1016/j.asjsur.2022.09.132.
[22]	Fan L L, Wang Y, Wu M L, et al. Laparoscopic common bile duct exploration with primary closure could be safely performed among elderly patients with choledocholithiasis[J]. BMC Geriatr, 2023, 23( 1): 486. DOI: 10.1186/s12877-023-04149-w.
[23]	Zheng C F, Wang W F, Peng Q Q, et al. Can laparoscopic common bile duct exploration be performed without any drainage? A propensity score-matched study[J]. Wideochir Inne Tech Maloinwazyjne, 2024, 19( 4): 427- 435. DOI: 10.20452/wiitm.2024.17909.
[24]	Chen Xiaoning, Hong Yiwei, Zhang Zhengwei, et al. Common problems and handling tips for cholangioscopy application in laparoscopic common bile duct exploration[J]. Chin J Pract Surg, 2025, 45( 11): 1329- 1332. DOI: 10.19538/j.cjps.issn1005-2208.2025.11.22. 陈晓宁, 洪艺玮, 张正伟, 等. 腹腔镜下胆总管探查术中胆道镜应用常见问题与处理技巧[J]. 中国实用外科杂志, 2025, 45( 11): 1329- 1332. DOI: 10.19538/j.cjps.issn1005-2208.2025.11.22.
[25]	Jia C K, Weng J, Chen Y K, et al. Hepatectomy with primary closure of common bile duct for hepatolithiasis combined with choledocholithiasis[J]. World J Gastroenterol, 2015, 21( 12): 3564- 3570. DOI: 10.3748/wjg.v21.i12.3564.
[26]	Zhan F, Jiang C, Yang L X, et al. Primary closure with self-disengaging biliary stent following laparoscopic CBD exploration in normal-diameter ducts: A propensity score matching study[J]. Sci Rep, 2025, 15( 1): 19959. DOI: 10.1038/s41598-025-04949-7.
[27]	Xiang L J, Li J J, Liu D Z, et al. Safety and feasibility of primary closure following laparoscopic common bile duct exploration for treatment of choledocholithiasis[J]. World J Surg, 2023, 47( 4): 1023- 1030. DOI: 10.1007/s00268-022-06871-9.
[28]	Omar M A, Redwan A A, Alansary M N. Comparative study of three common bile duct closure techniques after choledocholithotomy: Safety and efficacy[J]. Langenbecks Arch Surg, 2022, 407( 5): 1805- 1815. DOI: 10.1007/s00423-022-02597-3.
[29]	Hua J, Meng H B, Yao L, et al. Five hundred consecutive laparoscopic common bile duct explorations: 5-year experience at a single institution[J]. Surg Endosc, 2017, 31( 9): 3581- 3589. DOI: 10.1007/s00464-016-5388-6.
[30]	Ferreira A I, Xavier S, Dias de Castro F, et al. Diagnostic yield of endoscopic ultrasound in common bile duct dilation: A real breakthrough[J]. Dig Dis Sci, 2024, 69( 11): 4275- 4282. DOI: 10.1007/s10620-024-08628-x.
[31]	Liu Z Y, Chen X L, Xie Q, et al. Improved outcomes and prognostic risk prediction for laparoscopic common bile duct exploration with primary closure versus T-tube drainage[J]. Am J Transl Res, 2025, 17( 12): 9643- 9654. DOI: 10.62347/WFLH1075.
[32]	Teng Da, Xu Yue, Zhang Wei, et al. A comparative study on the efficacy of primary duct closure and T-tube drainage in the treatment of cholecystolithiasis complicated with choledocholithiasis in laparoscopic common bile duct exploration(LCBDE)[J]. Anhui Med J, 2023, 44( 4): 383- 387. DOI: 10.3969/j.issn.1000-0399.2023.04.005. 滕达, 许悦, 章伟, 等. 腹腔镜胆总管探查一期缝合与T管引流治疗胆囊结石合并胆总管结石的疗效对比[J]. 安徽医学, 2023, 44( 4): 383- 387. DOI: 10.3969/j.issn.1000-0399.2023.04.005.
[33]	Endo R, Satoh A, Tanaka Y, et al. Saline solution irrigation of the bile duct after stone removal reduces the recurrence of common bile duct stones[J]. Tohoku J Exp Med, 2020, 250( 3): 173- 179. DOI: 10.1620/tjem.250.173.
[34]	Wang Ping, Bao Hui, Song Zhenshun. Meta-analysis of comparative clinical outcomes between primary closure and T-tube drainage following laparoscopic common bile duct exploration and extraction combined with cholecystectomy[J]. J Surg Concepts Pract, 2025, 30( 2): 151- 158. DOI: 10.16139/j.1007-9610.2025.02.10. 王平, 包卉, 宋振顺. 腹腔镜胆总管探查取石联合胆囊切除术后一期缝合与T管引流临床疗效比较的荟萃分析[J]. 外科理论与实践, 2025, 30( 2): 151- 158. DOI: 10.16139/j.1007-9610.2025.02.10.
[35]	Chinese Medical Doctor Association, Chinese Committee of Biliary Surgeons. Expert consensus on enhanced recovery after surgery for biliary surgery(2016 edition)[J]. Chin J Dig Surg, 2017, 16( 1): 6- 13. DOI: 10.3760/cma.j.issn.1673-9752.2017.01.002. 中国医师协会外科医师分会胆道外科医师委员会. 胆道手术加速康复外科专家共识(2016版)[J]. 中华消化外科杂志, 2017, 16( 1): 6- 13. DOI: 10.3760/cma.j.issn.1673-9752.2017.01.002.
[36]	Chen Qing, Wu Erbin, Guo Zijian, et al. The experimental study on the natural healing process of common bile duct end-to-end anastomosis[J]. J Hepatobiliary Surg, 2011, 19( 3): 229- 231. DOI: 10.3969/j.issn.1006-4761.2011.03.029. 陈青, 吴二斌, 郭子健, 等. 胆总管端端吻合自然愈合过程的实验研究[J]. 肝胆外科杂志, 2011, 19( 3): 229- 231. DOI: 10.3969/j.issn.1006-4761.2011.03.029.
[37]	Wang Jie, Yang Shaochuan, Zhou Qing. The effect of primary suture in patients with choledocholithiasis undergoing laparoscopic common bile duct exploration with different common duct diameters[J]. J Chin Physician, 2024, 26( 12): 1824- 1829. DOI: 10.3760/cma.j.cn431274-20240219-00270. 王杰, 杨韶川, 周清. 不同胆总管直径的胆总管结石患者行腹腔镜下胆总管探查一期缝合的效果观察[J]. 中国医师杂志, 2024, 26( 12): 1824- 1829. DOI: 10.3760/cma.j.cn431274-20240219-00270.
[38]	Wang Xuhao, Sun Yuesheng, Wang Wenhuan, et al. Comparison of the effects between primary duct closure and T-tube drainage in laparoscopic common bile duct exploration[J]. J Hepatopancreatobiliary Surg, 2025, 37( 4): 254- 258. DOI: 10.11952/j.issn.1007-1954.2025.04.007. 汪栩好, 孙跃胜, 汪文寰, 等. 一期胆管缝合术和胆管内置T管引流术在腹腔镜胆总管探查术后的效果比较[J]. 肝胆胰外科杂志, 2025, 37( 4): 254- 258. DOI: 10.11952/j.issn.1007-1954.2025.04.007.