Objective:To evaluate the clinical efficacy of intra-biliary drainage versus T-tube drainage following laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis.Methods:The clinical data of 50 patients undergoing LCBDE for choledocholithiasis in Dalian Friendship Hospital of Dalian Medical University from January 2018 to October 2022 were retrospectively analyzed, including 23 males and 27 females, aged (61.3±16.2) years old. Patients were divided into the intra-biliary drainage group and T-tube drainage group. Propensity score matching was used to match the baseline data of the two groups at a 1∶1 ratio. The operation time, intraoperative blood loss, postoperative hospital stay, abdominal drainage tube indwelling time, postoperative bile drainage volume and postoperative complications were compared between the groups.Results:Compared with the T-tube group, the operative time [(155.0±36.5) min vs. (194.4±55.8) min], length of postoperative hospital stay [8.0(7.0, 8.0) d vs. 11.0(8.0, 13.0) d], and abdominal drainage tube indwelling time [5.0(4.0, 6.0) d vs. 6.0(5.0, 8.0) d] were all shorter in the intra-biliary drainage tube group (all P<0.05). The postoperative bile drainage volume was reduced [0 ml vs. 431.4(344.7, 484.3) ml]. No postoperative bile leakage occurred in either group. The intraoperative blood loss, proportion of postoperative residual stone, stone recurrence and biliary stricture were comparable between the two groups (all P>0.05). Conclusion:Intra-biliary tube drainage following LCBDE could be safe and effective for choledocholithiasis. Compared to the classic procedure of T-tube drainage, it may be superior in the operation time, postoperative hospital stay, abdominal drainage tube indwelling time, postoperative bile drainage volume.

The chronic use of morphine and other opioids is associated with opioid-induced hypersensitivity (OIH) and analgesic tolerance. Among the different forms of OIH and tolerance, the opioid receptors and cell types mediating opioid-induced mechanical allodynia and anti-allodynic tolerance remain unresolved. Here we demonstrated that the loss of peripheral μ-opioid receptors (MORs) or MOR-expressing neurons attenuated thermal tolerance, but did not affect the expression and maintenance of morphine-induced mechanical allodynia and anti-allodynic tolerance. To confirm this result, we made dorsal root ganglia-dorsal roots-sagittal spinal cord slice preparations and recorded low-threshold Aβ-fiber stimulation-evoked inputs and outputs in superficial dorsal horn neurons. Consistent with the behavioral results, peripheral MOR loss did not prevent the opening of Aβ mechanical allodynia pathways in the spinal dorsal horn. Therefore, the peripheral MOR signaling pathway may not be an optimal target for preventing mechanical OIH and analgesic tolerance. Future studies should focus more on central mechanisms.
Humans ; Morphine/pharmacology* ; Hyperalgesia/metabolism* ; Analgesics, Opioid/pharmacology* ; Neurons/metabolism* ; Signal Transduction