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CN 22-1108/R
Volume 42 Issue 7
Jul.  2026
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Article Navigation >  Journal of Clinical Hepatology  > 2026  >  42(7): 1648-1655

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

DOI: 10.12449/JCH260722
  • 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）
  • Received Date: 2025-12-19
  • Accepted Date: 2026-04-09
  • Published Date: 2026-07-25
    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.

     

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    • References(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.
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