Clinical Analysis And Observation Of Laparoscopic Treatment Of Common Bile Duct Stone Patients With Cirrhosis

Objective: To investigate the safety,reliability and clinical efficacy of laparoscopic common bile duct exploration in Cirrhotic patients with common bile duct stones combined with cirrhosis.Materials and Methods: Between June 2010 and June 2016,a total of 178 ordinary patients with choledocholithiasis underwent common bile duct(CBD)explorations in our department.There were two groups of ordinary patients: A: LCBDE(n = 107)and B: OCBDE(n = 71).A total of 187 cirrhotic patients with choledocholithiasis underwent CBD explorations in our department.There were two groups of cirrhotic patients: C: LCBDE(n = 112)and C: OCBDE(n = 75).Patients’ demographic characteristics,surgical data,postoperative outcomes,and long-term results were retrospectively collected and analyzed.Results: In terms of stone clearance rate and postoperative hematology test,the difference between group A and B were not statistically significant(P>0.05),but the operation time of group A was significantly shorter than that in group B(109.2+40.2 VS,122.1+45.5min,p=0.048);the blood less in the A group was significantly less than that in group B(40.8+23.3 VS 65.5+28.2ml,P<0.001),postoperative hospital stay was significantly shorter than that in group B(4.5+2.8 VS,7.8+3.0d,p<0.05).In terms of the operation time,postoperative hospital stay,conversion rate,stone clearance rate,short-term complication rate,the difference between group A and C were not statistically significant(P>0.05),but the blood loss of group A was significantly less than that in group C(40.8+23.3 VS 81.4+24.1ml,P<0.001).The differences between group C and group D in terms of stone clearance rate,postoperative hematology test,short-term complication rate were not statistically significant(P>0.05),but the operation time of group C was significantly shorter than that in group D(5.2+2.6 VS,9.7+3.1d,p<0.05),the blood loss in group C was significantly less than that in group D(81.4+24.1 VS,100.1+29.3ml,p<0.001).After a median follow-up of 41.7 months,the recurrence rate of group C was 6.2%,the recurrence rate of group D was 5.4%,there was no significant difference between the two groups(P>0.05);No patient of group C and D had biliary injury or stricture during the follow-up period.Conclusion: LCBDE is safe and feasible for ordinary patients with common bile duct stones,and has the advantages of shorter operation time,less blood loss and shorter postoperative hospital stay.LCBDE is safe and feasible for patients with Child-Pugh A or B cirrhosis and choledocholithiasis,with minimal short-term complications and acceptable long-term outcomes.Compared with open CBD exploration for patients with Child-Pugh A or B cirrhosis and choledocholithiasis,LCBDE has the advantages of less blood loss and postoperative shorter hospital stay.